THERAPEUTICS 



OF 



NERVOUS DISEASES; 



INCLUDING ALSO THEIR 



DIAGNOSIS AND PATHOLOGY. 



BY 



/ 



CHARLES PORTER HART, M.D., 

LATE PROFESSOR OF DISEASES OF THE NERVOUS SYSTEM IN HAHNEMANN HOSPITAL COLLEGE, 
SAN FRANCISCO ; HONORARY MEMBER OF THE COLLEGE OF PHYSICIANS AND SURGEONS 
OF MICHIGAN; MEMBER OF THE AMERICAN ASSOCIATION FOR THE ADVANCEMENT 
OF SCIENCE; CORRESPONDING MEMBER OF THE CALIFORNIA STATE HOMOEOPA- 
THIC MEDICAL SOCIETY ; FORMERLY SURGEON-IN-CHARGE OF THE SURGI- 
CAL AVARDS, CHIEF SURGEON TO THE EYE DEPARTMENT, AND 
PRESIDENT OF THE BOARD OF MEDICAL EXAMLNERS, OF 
BROWN GENERAL HOSPITAL, U. S. A., LOUISVILLE, 
KY. ; AUTHOR OF TREATISES ON "DISEASES 
OF THE NERVOUS SYSTEM," "INTRACRA- 
NIAL DISEASES," "DISEASES OF 
THE SPINAL MARROW AND 
ITS COVERINGS," 
ETC., ETC. 





PHILADELPHIA : 

F. E. BOERICKE, 

HAHNEMANN PUBLISHING HOUSE. 

1889. 






* 






Copyright, F. E. Boericke, 1889. 




SAMUEL LILIENTHAL, M.D., 

PROFESSOR OF NERVOUS DISEASES IN THE HAHNEMANN HOSPITAL COLLEGE 

OF SAN FRANCISCO, 

THIS VOLUME 

IS RESPECTFULLY INSCRIBED BY HIS FRIEND AND CO-WORKER, 

The Author. 



PREFACE. 



When the author of this work first published his Treatise on 
Diseases of the Nervous System, our practical knowledge of the 
therapeutics of nervous diseases was, if not in its infancy, at 
least far behind what it is to-day. Not only was our clinical 
experience in many of these affections exceedingly scanty, but 
as to some of their forms was entirely wanting. Not only so, 
but much of what was recorded was wholly unreliable, and 
therefore worthless. It was unreliable, because many diseases 
of the nervous system which are now known to depend on 
organic alterations of nerve tissue were then believed to be 
purely functional, and the temporary ameliorations incident 
to their course were frequently supposed to be the effects of 
medical treatment. But now, it may be truthfully affirmed, 
our knowledge of the pathology and therapeutics of nervous 
diseases will compare favorably with that of any other class of 
disorders. The improvement is mainly due to the fact that in 
most of our colleges competent professors of nervous diseases 
have for years been constantly and earnestly engaged, not only 
in imparting a knowledge of these diseases to medical students 
— among whom are included the majority of our present 
practitioners — but in clinical investigations, based upon the 
homoeopathic law, many of which have resulted in important 
therapeutic discoveries. The consequence is, but few definite 
lesions of the nervous system remain unprovided with remedies 
possessing well-recognized and clearly defined characteristic 
properties homoeopathic thereto, while the therapeutic effects 
of those previously employed are now, as a rule, better under- 
stood and more specifically determined. In short, it is gratify- 
ing to know that we are at present in the full tide of success 
as regards the study and scientific treatment of this important 
class of diseases. 



4 PREFACE. 

No apology, therefore, would seem to be needed for the 
appearance of the present work. On the contrary, the time 
has arrived when, in the author's opinion, such a Manual of 
Nervous Therapeutics as is here presented is demanded in the 
interests of our School. 

As the chief excellence of a work of this kind is reliability, 
the author has been careful to make use of only such material, 
out of the large amount available for the purpose, as he could 
safely and fully indorse. Hence, comparatively few of the 
more recently introduced remedies have been admitted, except 
under the head of auxiliary treatment. This is especially true 
as regards those occasionally employed in the treatment of the 
more common nervous disorders, such as neuralgia, convul- 
sions, etc., for the successful management of which we already 
have an abundance of well-tried remedies. In excluding a 
number of the more recent, irregular and unproved remedies, 
the author is conscious of the fact that he has no doubt omitted 
some which have proved curative in particular cases. But it 
is a relief to him to know that deficiencies of this sort are quite 
unavoidable. As Grauvogl has well remarked : " It is impos- 
sible to prepare a complete special Therapia for any so-called 
disease." In other respects, also, the work doubtless has its 
imperfections, as, indeed, every such work must have, since 
there is yet a great deal to learn regarding the nature and 
treatment of nervous and mental diseases. The importance, 
however, of having what we do know concisely set forth will, 
the author trusts, be regarded as a sufficient excuse, if any 
were needed, for adding another supplementary volume to his 
series of works on diseases of the nervous system. 

In conclusion he would remark, that his chief aim has been 
to furnish a handy, practical guide to the successful treatment 
of every form of nervous disease, by presenting in one small 
volume the diagnosis, pathology and therapeutics of one of the 
most interesting, important and progressive departments of 
medicine. 

Charles Porter Hart. 

Wyoming, 0., Sept., 1889. 



CONTENTS. 



PART I. 
Diseases op the Brain and its Membranes. 

Page 

Cerebral anaemia 9 

Cerebral hyperemia 14 

Cerebral haemorrhage . . . - 21 

Cerebral thrombosis 27 

Cerebral embolism 30 

Encephalitis 32 

Cerebral softening 34 

Aphasia 37 

Cerebral hypertrophy 39 

Cerebral atrophy 40 

Multiple cerebral sclerosis 42 

Athetosis 44 

Cerebral syphilis 45 

Cerebral tumors . , 48 

Cerebral concussion 50 

Sunstroke 52 

Cerebral paralysis 54 

Infantile cerebral paralysis 56 

External cerebral pachymeningitis 58 

Internal cerebral pachymeningitis 59 

Cerebral arachnitis 60 

Traumatic cerebral leptomeningitis 61 

Simple acute cerebral meningitis 62 

Tubercular cerebral meningitis » 67 

Chronic cerebral meningitis 71 

Chronic hydrocephalus 73 



CONTENTS. 

PART II. 

Diseases of the Spinal Marrow and its Membranes. 

Page 

Spinal hyperemia ^ 76 

Spinal anaemia 78 

Spinal irritation 81 

Spinal haemorrhage 84 

Spinal meningitis 85 

Myelitis 88 

Myelomalacia 90 

Spinal paralysis . . 92 

Acute ascending paralysis 94 

Spinal paralysis of adults ■ 95 

Infantile spinal paralysis ' . . 97 

Pseudo-hypertrophic spinal paralysis 98 

Glosso-labio-laryngeal paralysis 99 

Progressive muscular atrophy 101 

Amyotrophic lateral sclerosis 102 

Multiple spinal sclerosis 103 

Primary spinal sclerosis 104 

Secondary spinal sclerosis 106 

Posterior spinal sclerosis 107 

Spinal tumors and other abnormal growths 112 

Spinal concussion 112 



PART III. 

Cerebro-spinal Diseases. 



Pagb 

Cerebro-spinal hypersemia 116 

Neurasthenia 117 

Cerebro-spinal meningitis 123 

Infantile convulsions 129 

Postnatal convulsions 133 

Puerperal convulsions 134 

Toxsemic convulsions 138 

Epilepsy 139 

Tetanus 144 

Hydrophobia 148 

CChorea 152 

Hysteria 156 

Hystero- epilepsy • 159 



CONTENTS. 7 

Page 

Catalepsy 161 

Multiple cerebro-spinal sclerosis 162 

Secondary cerebro-spinal sclerosis 162 

General paralysis .... 163 

Paralysis aaitans 164 



PAKT IV. 

Diseases of the Peripheral Nervous System. 



Page 



Xeuritis 166 

Neuralgia (in general) 167 

Trigeminal neuralgia 171 

Mastodynia 174 

Coccygodynia 175 

Sciatica 177 

Pharyngeal paralysis 181 

Paralytic aphonia 181 

Facial paralysis 183 

Diphtheritic paralysis 185 

Glossoplegia 186 

Facial spasm • 187 

Torticollis 187 

Writer's cramp 188 

Spasm of the glottis 189 

Facial atrophy 191 

Peripheral anaesthesia 192 



PART V. 

Diseases of the Sympathetic Nervous System. 

Page 

Hemicrania . 195 

Exophthalmic goitre 198 

Myxcedema 199 

Angina pectoris 200 

Gastralgia • 204 

Ovaralgia 208 

Hysteralgia 210 

Enteralgia 211 



8 CONTENTS. 

PART VI. 

Symptomatic Diseases. 

Page 

Cephalalgia 214 

Vertigo 223 

Coma somnolentum 229 

Insomnia < 232 



PART VII. 
Mental Diseases. 

Page 

Melancholia 237 

Hypochondriasis 240 

Moral insanity 241 

Mania 243 

Dipsomania 249 

Mania a potu 250 

Dementia 252 



THERAPEUTICS 



OF 



NERVOUS DISEASES 



PART I. 
DISEASES OF THE BRAIN AND ITS MEMBRANES. 



CEREBRAL ANEMIA. 



Synonyms. — Brain-Fag, Cerebral Hypsemia, Cerebral Hy- 
psemia et Hydremia, Cerebrasthenia, Neurasthenia Cerebralis; 
Fr., Anemie Cerebrate; Ger., Anamie des Gehirns, Gehirn-anamie. 

Definition. — A condition in which the blood contained in 
the cerebral vessels is deficient in quantity or defective in 
quality. 

Diagnosis. — The history of the case is usually sufficient to 
establish the diagnosis. When, as is sometimes the case, the 
symptoms resemble those of cerebral hyperemia, the condition 
may be recognized by the following comparison : 



Cerebral Anaemia. Cerebral Hyperemia. 



Patient anaemic, weak and pale. 
Disposition to sleep. 



Patient plethoric, red face. 
More or less insomnia. 



Pulse small and weak. Pulse full. 

Neuralgic headache, chiefly limited to Cephalalgia of a dull, aching character, 

forehead and vertex. and diffused. 

Pupils dilated. ; Pupils contracted. 

Relieved by stimulants and horizontal Aggravated by stimulants and by lying 

position. down. 

Anaemic murmurs. I No abnormal heart sounds. 

- (9) 



10 NERVOUS THERAPEUTICS. 

Pathology. — That the characteristic symptoms of cerebral 
anaemia are due, in most cases, to an insufficient supply of 
blood to the brain may be readily shown by diminishing the 
supply by compression of the carotid arteries, or by simply 
suppressing the breathing. When caused by an impoverished 
condition of the blood, the nutrition of the brain suffers 
through a deficiency of the red corpuscles, which are the car- 
riers of oxygen. In these cases the effects are similar to those 
resulting from a deficiency in quantity, the chief difference 
being that the symptoms are gradually instead of suddenly 
developed. 

Clinical Experience. — China, Ferrum and Digitalis, aided by 
a blood-making diet, have generally proved successful where 
there was a deficiency of blood, the Digitalis being most useful 
in cases attended by feeble action of the heart. The vaso-motor 
form of cerebral anaemia generally yields promptly to Amyl 
nitr., Glonoin, Picric ac. and Amm. brom. 3x. Chronic cases 
have been greatly benefited by Nux vom. and Phosphorus. Ver- 
tigo generally yields to Ac. fluor., Baryta carb., Graph., Lycop. 
and Silicea. Hale has found Atropine 2 "an admirable remedy 
in cases of advanced typhoid, when, with the general prostra- 
tion, there is insomnia, with incoherent mumbling, coma vigil 
and very dry tongue." I have found Picric ac. 6 well suited to 
this condition. 

Therapeutic Indications. — China. — This remedy justly 
stands at the head of the list of remedies for anaemia, when 
caused by the excessive loss of animal fluids, as in haemor- 
rhage, diarrhoea, leucorrhoea, spermatorrhoea and overlactation. 
Its best effects are observed only after the drain upon the system 
has been arrested. The symptoms calling for it are : headache, 
especially in the morning; ringing in the ears; pale, cold face ; 
coldness of the extremities; great debility; tingling and trem- 
bling, or twitching, of the muscles and limbs ; palpitation of 
the heart; faintness, which is relieved by lying down; insom- 
nia ; vertigo, especially on raising the head. 

Arsenicum. — This is a good blood-making remedy, and is 
best adapted to cases where the blood has become too watery, 
or depraved, as in malarial fever, chronic quininism and chlo- 



CEREBRAL AN.EMIA. 11 

rosis. It is also suited to cases aggravated by injudicious use 
of Ferrum. Tlie indications are: great prostration, with rapid 
sinking of the vital forces; hammering headache; coldness of the 
extremities; restlessness; bloating of the hands, feet and face; 
thirst for small quantities of water; nausea; tendency to syn- 
cope on raising the head ; vertigo, with vanishing of the senses ; 
chilliness; mental depression. 

Ferrum. — Cerebral anaemia dependent on hydremia, as shown 
by great pallor of the face, lips and buccal mucous membrane ; 
bellows-sound of the heart ; muscles flabby and weak; beating 
headache; slight exertion produces shortness of breath and 
exhaustion. This remedy is generally best adapted to chlor- 
otic cases and to those resulting from passive haemorrhages. 

Avena sat. — Coldness of different parts of the body, depend- 
ing upon want of nerve-force; brain-fag; nervous debility of 
school teachers and professional men ; women who have be- 
come anaemic and debilitated by household cares, worry, over- 
nursing, etc. 

Nux vom. — Anaemia from mental exhaustion or overwork, 
as in students and professional people; also the anaemia re- 
sulting from debauchery and overstimulation, the long-con- 
tinued use of ardent spirits, late hours and high-seasoned food. 
Especially indicated in all cases where there is gastric irrita- 
tion, indigestion or constipation; nausea and vomiting, with fre- 
quent eructations of sour- smelling fluids or food; insomnia; mus- 
cular twitchings; trembling of the hands ; frequent cramps. 

Camphor. — Syncopal form, resulting from the rapid loss of 
vital fluids, and causing great embarrassment of the respiration 
and circulation, spasms and convulsions; coldness of the body, 
vertigo and loss of consciousness. This is a transiently acting 
remedy, but very useful in meeting the primary symptoms, 
especially when caused by diarrhoea, cholera, etc. 

Ignatia. — Cases occurring in weak, hysterical subjects, or in 
women who have become ansemic through grief or mental anxiety; 
melancholy, taciturn, nervous, seeks solitude, frequently gives 
way to tears ; sinking sensation at the pit of the stomach ; con- 
stipation ; overlactation. 

Helonias. — Cases resulting from diseases of the female sexual 



12 NERVOUS THERAPEUTICS. 

organs; menorrhagia ; leucorrhoea, with general atony; pro- 
lapsus uteri; loss of sexual appetite; pains in the back from 
weakness and congestion ; pulsative pains in the top of the head, 
increased by stooping, and attended by vertigo. 

Pulsatilla. — Cerebral anaemia due to impoverishment of the 
blood, and associated with menstrual irregularity, especially in 
young girls approaching the period of adolescence; amenorrhcea, 
with vertigo, chilliness, peevishness, aching pain in the small 
of the back, beating headache, aggravated by stooping, bloat- 
ing of the face, hands and feet ; hysterical cases, with pale face, 
disposition to faint and tremulous weakness. 

Cilia. — Hydrocephaloid cases, with marked paleness of the face, 
especially around the nose and mouth ; transient dizziness, with 
double vision and obscuration ; dilated pupils ; spasms and 
convulsions; paresis; verminous irritation, producing irrita- 
tive fever. 

Ipecacuanha. — Anaemia produced by the summer complaint 
in children, and attended with nausea, with or without vomit- 
ing, pale face, with blue margins around the eyes, coldness of the 
extremities ; restlessness and sleeplessness, or else great drowsi- 
ness ; convulsive movements of the limbs ; stools frequent, emerald- 
green, foetid, and ejected with great force. 

Calcarea phos. — Chronic cases, caused by malnutrition ; 
ansemic headache of school girls ; weakly, anaemic children, with 
retarded development, especially of the teeth and osseous structures; 
hydrocephaloid cases. 

Zincum. — Well adapted to old chronic cases, especially when 
caused by the abuse of potassium bromide. Great mental and 
bodily depression ; cold extremities ; twitching of the muscles, 
with paralytic weakness ; aching in the forehead after reading, 
writing or study; loss of memory ; restlessness at night, with 
frightful dreams. 

Zincum phos., brom. and pier. — The indications for the employ- 
ment of these remedies are: brain-fag of business men, teachers 
and professional men, who have become pale, haggard, weak 
and sleepless from overwork, worry and prolonged mental 
exertion. 

Veratrum album. — Acute cases caused by violent purging, at- 



CEREBRAL AN.KMIA. 13 

tended with fainting, spasms and convulsions, and followed or 
accompanied by paralytic weakness. 

Secale cor. — Anaemia complicated with diarrhoea or metror- 
rhagia, or with spasms and convulsions; small, intermitting 
pulse; tinnitus aurium; delirium; loss of consciousness; 
numbness and coldness of the limbs. 

Natrum sulph. — Watery condition of the blood; constant chilli- 
ness; hydrogenoid constitution; trembling of the body, with 
jerking of the limbs; great languor and prostration. 

Natrum mur. — Cerebral anaemia due to malarial poisoning; 
profound melancholy ; circulation excited by every movement of 
the body; great weakness and constipation; pale, sallow com- 
plexion; effects of onanism. 

Sulphur. — Chronic cases, occurring in cold, phlegmatic, 
scrofulous constitutions; also when preceded or accompanied 
by eruptions, or when caused by their suppression ; also as an 
intercurrent remedy, or when indicated medicines fail to pro- 
duce any lasting benefit. 

Auxiliary Treatment. — When the anaemia is due to a 
sudden or copious loss of blood, its quality should be improved 
by such articles of diet as are not only easy of digestion, but 
rich in blood-making elements; such as beef, milk, eggs, game, 
fish, oysters, vegetables, etc. Only good food makes good 
blood; hence pies, pastry, rich cake and all unwholesome 
articles of diet should be strictly forbidden, and not permitted 
to displace a liberal allowance of good nutritious aliment. 
Fresh air and exercise are also of great importance, especially 
in chronic cases. An ocean voyage, exposure to the mountain 
or sea air, or even a complete change of climate, may be re- 
quired in order to fully restore the patient to health. In very 
bad cases, rest in the horizontal position, massage and electri- 
city may not only be found serviceable, but even indispensable. 
Salt-baths and sea-bathing are invigorating, and can generally 
be practiced with great benefit, provided proper precautions 
are taken at the commencement, and the exposure made to 
correspond at all times with the strength and susceptibility of 
the patient. 



14 NERVOUS THERAPEUTICS. 



CEREBRAL HYPEREMIA. 

Synonyms. — Congestion of the Brain ; Fr., Hyperemie Cere- 
brate ; Ger., Hyper cimie des Gehirns, Gehirn-hyperdmie. 

Definition. — An increase in the quantity of blood within 
the cerebral vessels, causing a condition of congestion, undue 
pressure and more or less irritation. 

Diagnosis. — Congestion of the brain should be carefully 
distinguished from cerebral anaemia, auditory and gastric ver- 
tigo, epilepsy, embolism and thrombosis of cerebral blood- 
vessels, softening of the brain and urinaemia, to all of which 
its symptoms bear more or less resemblance. The differential 
diagnosis between cerebral congestion and cerebral anaemia is 
given under the latter head, and need not be repeated here. 

Cerebral congestion differs from cerebral haemorrhage in the 
apoplectic symptoms being less pronounced. Thus, there are 
no stertorous breathing and no puffing of the lips; nor are 
consciousness, sensibility and the power of motion completely 
lost, as in cases of haemorrhage. 

Auditory and gastric vertigos are simply ear and stomach 
troubles, the former due to disease of the semicircular canals, 
and the latter to indigestion, which is always present at the 
time of the attack. 

In epilepsy an aura is often present, and this is generally 
followed by a peculiar cry; the patient falls suddenly, instead 
of slowly, to the ground, and the tongue is frequently bitten, 
none of which symptoms belong to cerebral congestion. 

In embolism the pulse and respiration are disturbed, being 
more or less irregular and rapid, owing to valvular disease of 
the heart, which is usually present; the heat of the head is not 
increased in this disease, there is no premonitory stage, and the 
symptoms are more permanent than they are in cases of cere- 
bral hyperaemia. 

In thrombosis, aphasic and paralytic symptoms are usually 
present from the beginning, and, notwithstanding occasional 
remissions, they gradually become more and more pronounced 
as the disease progresses. 

In cerebral softening the accession may be either gradual 



CEREBRAL HYPEREMIA. 15 

or sudden, but the paralysis is permanent and progressive, the 
speech is seriously impaired, the intellect is feeble and the 
disease fatal. 

Urinsemia may be distinguished from cerebral congestion 
by the evidence afforded by a chemical and microscopical ex- 
amination of the urine, by the anasarcous condition of the face 
and limbs, and by the frequent recurrence of convulsions and 
coma. 

Pathology. — The essential pathological element in cerebral 
hyperemia is the congested state of the capillary vessels of the 
brain, and to this is due the functional disturbance or irrita- 
tion of that organ. The congestion is active when, owing to 
arterial dilatation, oxygenated blood passes rapidly through 
the cerebral capillaries; and passive, when, from venous ob- 
struction, the capillaries contain mostly venous blood, which 
moves sluggishh 7 through them. 

Clinical Experience. — -Aconite, Glonoin, Belladonna and 
Hyoscyamus are generally prescribed in cases of acute active 
congestion, the last two being preferred when there is a marked 
tendency to delirium. Hale uses large doses (15 grs.) of Natr. 
brom. and Kali brom. in these cases, which he pronounces supe- 
rior to either Aconite or Belladonna. Opium and Apis have 
been given successfully in the apoplectic form, or when there 
was great cerebral depression. Gelsemium and Veratrum vir. y 
both low, are usually given in cases of recent passive or venous 
hyperemia, the latter being preferred when the blood pressure 
is very great, the face livid and the veins greatly distended. 
Nux vom. and Arnica are used in chronic cases, the former 
being prescribed for high livers and persons of sedentary life, 
and the latter in paralytic cases, or where there is a suspicion 
of thrombosis. Bryonia, Phosphorus, Salicylic ac. and Cuprum 
have also been given successfully in special cases. 

Therapeutic Indications. — Grlonoin. — Acute active conges- 
tion of the brain, with strong beating of the carotid and 
temporal arteries, contracted pupils and very rapid pulse; 
throbbing headache, with flashes of light before the eyes ; tin- 
nitus aurium ; fulness in the forehead and vertex, with mental dul- 
ness; vertigo, with impaired vision; great restlessness and im- 



1G NERVOUS THERAPEUTICS. 

patience in mild cases ; apoplectic and epileptiform cases, 
especially when caused by exposure to the sun's heat or by 
menstrual suppression. 

Belladonna. — Acute cases attended by delirium or by spasms 
and convulsions ; redness of the face and eyes ; morbid vigil- 
ance ; sensitiveness to light and noise ; contraction of the 
pupils; stiffness of the tongue and neck; throbbing headache; 
great mental excitement ; double vision ; children start suddenly 
when falling asleep. 

Aconite. — Great restlessness and anxiety, with dry, burning 
shin and a full bounding pulse; throbbing in the head, with 
sense of fulness and heaviness ; contracted pupils ; vertigo, 
especially when stooping; heat, thirst and delirium; cardiac 
palpitation. This remedy is specially indicated when the 
attack is due to great emotional excitement or exposure to 
extreme heat. 

Hyoscyamus. — Dark red face and sparkling eyes ; violent de- 
lirium ; lascivious mania ; epileptiform attacks ; muscular 
twitchings ; great nervousness ; double vision ; grating of the 
teeth. Acute attacks in which the nervous and mental phe- 
nomena predominate. 

Stramonium. — This remedy is indicated in cases similar to 
those for which Hyoscyamus is recommended, the nervous ex- 
citement being extreme, and the delirium of the most active 
and furious character. The patient laughs, sings and gesticulates 
in rapid succession, or shows great fright, terror or rage. In 
milder cases, vertigo and temporary blindness are special indi- 
cations. 

Amyl nit. — Throbbing of the cerebral vessels, with sense of 
heat and fulness in the head ; buzzing and throbbing in the 
ears; protrusion of the eyes, with flushing of the face; visible 
pulsations of the carotids ; violent cardiac action. At the very 
beginning of active cerebral hyperemia. 

Bryonia. — Painful outward pressure in the forehead and 
temples; active cerebral circulation, attended with bleeding of 
the nose; muscular twitchings during sleep; face red and 
puffed ; gastric disturbances and constipation. 

Gelsemium. — Dull, pressive and stupefying headache, extend- 



CEREBRAL HYPEREMIA. 17 

ing from os front is to occiput; vertigo, dimness of vision and 
diplopia; drowsiness and mental confusion; dull, aching pain 
in the nape of the neck, with disposition to throw the head backward; 
great muscular prostration ; dropping of the upper eyelids. Most 
useful in the passive form of cerebral congestion, especially in 
malarial cases. 

Veratrum vir. — Fulness and sense of weight in the head, with 
vertigo, confusion of mind and loss of memory; oppressed res- 
piration; labored action of the heart; tingling and numbness in 
the limbs. Passive congestions, especially such as result from 
alcoholic stimulants and malarial poisoning. 

Opium. — Apoplectic cases, with dark red and bloated face, slow 
pulse and difficult articulation ; great drowsiness, with confusion 
of mind, and sense of heaviness and pressure wdthin the head; 
coldness of the hands and feet, with mumbling delirium. 
Suited to the passive and apoplectic forms, and also such as 
arise from fright or debauchery. 

Apis mel. — Sense of fulness and heaviness of the head, es- 
pecially in the occiput ; burning and throbbing in the head, 
greatly aggravated by stooping; vertigo, with nausea; drowsi- 
ness, with inability to sleep, owing to extreme nervousness; 
redness and burning of the eyes and eyelids ; sleep disturbed 
by oppressed breathing and unpleasant dreams. Most suitable 
in cases characterized by great cerebral depression. 

Nux vomica. — Gastric derangement, w T ith dulness and con- 
fusion of the head ; sleeplessness during the latter part of the 
night; drowsiness, with a tendency to coma; symptoms ag- 
gravated by coffee, eating and exercise in the open air. Con- 
stipation, haemorrhoids and derangements of the stomach 
point to this remedy, especially in chronic cases caused by ex- 
cessive mental labor, sedentary modes of life, overstimulation 
by alcohol, the abuse of tobacco, w T orry and loss of sleep. 

Arnica. — Heat and burning in the head, with coldness of the 
rest of the body; throbbing in the forehead and temples, in- 
creased by stooping or exercise; tinnitus aurium; vertigo, at- 
tended w T ith nausea, obscuration of sight or loss of conscious- 
ness; delirium. Chronic congestions, and also such as result 
from mechanical violence. 



15 NERVOUS THERAPEUTICS. 

Phosphorus. — Heat and throbbing in the head, with vertigo, 
buzzing in the ears and heat in the vertex; lightning-like pains 
in the head; sense of weight in the forehead, increased by 
stooping. Chronic cases, and such as are due to mental strain 
or overwork. 

Cuprum. — Violent convulsive movements, either general or 
local; restless tossing about and constant uneasiness; pulse full, 
quick and strong; eyes red and inflamed, looks wild, and 
speech delirious; excessive thirst. Cases resulting from sup- 
pressed eruptions or retrocedent exanthemata. 

Cimicifuga. — Dull, heavy feeling in the head; pain in the 
temple and vertex, with a sensation of pressure; heat and ful- 
ness in the- head, with throbbing and pressure; pain in and 
behind the eyes, also in the back of the head and neck ; the 
brain feels too large for the skull ; sensation as if the top of 
the head would fly off; severe pain over the right eye. Cere- 
bral congestion, involving especially the base of the brain and 
complicated with spinal irritation. 

Aurum. — Heat and roaring in the head ; scintillations before 
the eyes; extreme melancholy, desire for death and suicidal 
tendency ; symptoms aggravated by mental exertion. 

Coffea. — Heat in the head and face, with flushing ; bleeding 
of the nose ; great nervousness and exaltation of the senses ; 
hot head, red and glistening eyes and cold feet. Infantile 
cases occurring during the period of dentition, especially when 
associated with diarrhoea. 

Lachnanthes. — Dull headache, with sensation of upward press- 
ure in the vertex ; vertigo, with feeling of heat and congestion 
in the chest; great outward pressure behind the eyes; burning 
sensation in the head, while the w r hole body feels cold ; expan- 
sive feeling in the head, as if it was being split open. 

Rhus tox. — Burning, throbbing pains in the head, with sense 
of fulness; red and burning, or pale and puffy face; vertigo 
when lying down; great restlessness, especially at night; waver- 
ing sensation in the brain; pains reappear after eating. Es- 
pecially adapted to cases caused by prolonged exposure to 
extreme cold, or by standing in cold water. 

Asclepias syr. — Headache, with vertigo, dulness and stu- 



CEREBRAL HYPEREMIA. 19 

pidity; sharp, stabbing pain*, extending from one temple to tlie 
"(Jar: severe headache, with quick, full pulse and nausea; 
feeling of constriction across the forehead; scanty urine. This 
remedy is particularly indicated in cases where the perspira- 
tion has been suddenly suppressed. 

Pulsatilla. — Oppressive, beating headache, with confusion of 
mind ; red and bloated face, with bright sparks before the eyes; 
vertigo, with tinnitus aurium; double vision, nausea and pal- 
lor of the face; bitter taste in the mouth; drowsiness during the 
day and sleeplessness at night; scanty or suppressed menses; 
symptoms worse in a warm room; ameliorated by pressure, or 
by going into the open air. Especially called for in cases 
caused by a sudden suppression of the menses, particularly in 
young girls. 

Sulphur. — Rush of blood to the head, producing redness and 
heat of the face, vertigo, and a sense of fulness and pressure 
within the cranium, with violent throbbing; pale face, with 
coldness of the extremities. As an intercurrent remedy in 
chronic cases. 

Auxiliary Treatment. — The removal of the cause is gen- 
erally the first thing to be considered, for whenever it can be 
effected it will greatly benefit the patient, and in many cases 
accomplish a cure. Where the exciting causes cannot be 
entirely removed, they may be lessened, and their injurious 
effects greatly palliated. Thus, the passive form requires rest, 
both physical and mental; hence all excess in eating and 
drinking, all excitement or gratification of the animal appe- 
tites and passions, in short, every form of bodily and mental 
exertion, should be studiously avoided. The active form re- 
quires similar restrictions, except that the injunction as to rest 
need not, as a rule, be insisted on to so great an extent. The 
patient, however, if able to be about, should abstain from all 
severe muscular exertions, especially in a stooping posture. 
But moderate exercise in these cases is often of great benefit. 
Dr. Kershaw relates several cases which were greatly benefited 
by regular and judiciously taken exercise, such as walking, 
riding, etc., carefull}' regulated according to the strength and 
health of the patient. 



20 NERVOUS THERAPEUTICS. 

Professor Preyer, of Jena, claims to withdraw an excess of 
blood from the brain by making his patient stand with one 
arm outstretched until the limb aches violently. By conduct- 
ing the excess of blood to the arm in this way, the brain is 
relieved, and a cure speedily effected. 

Cold to the head is often of great benefit in the active form of 
the disease, if systematically applied. When the hyperemia 
is intense and the pupils very much contracted, ice and ice- 
water should be applied to the head and neck until the symp- 
toms abate, which may not be under several days, or even 
weeks. I recently succeeded in curing a very severe case in 
this manner, in a patient over seventy years of age, and a hard 
drinker at that, the congestion continuing over a period of 
from six to eight weeks, more than four hundred pounds of ice 
being used ! Of course, such heroic treatment is only suited to 
cases of the most active and intense form, with a very high 
temperature, bounding pulse and greatly contracted pupils. 
In mild cases it will be better and safer to use warm water in- 
stead of cold, as the evaporation from it not only produces a 
comfortable sense of coolness, but causes no depression, and is 
followed by no injurious reaction. 

There are various agents known to possess the power of con- 
tracting the cerebral capillaries, such as galvanism, ergot and 
the alkaline bromides. These are sometimes useful as pallia- 
tives, and may be employed with benefit in cases where the 
homceopathically indicated remedies, from any cause, appear 
to be inadequate to the complete removal of the hypersemic 
condition, which, however, will seldom be found to be the case. 

The constant galvanic current should be applied by placing 
one sponge over the sympathetic nerve in the neck, and the 
other over the spine, opposite the seventh cervical vertebra. 
The current from eight or ten Smee's or Leclanche cells, acting 
not to exceed three or four minutes at any one time, will be 
sufficient for the purpose. 

Ergot and the bromides, being allopathic remedies, require 
to be used in material doses. Hammond advises the former 
in drachm doses of the fluid extract, and the latter in twenty- 
grain doses, in solution, three times a day. I have seldom had 



CEREBRAL HEMORRHAGE. 21 

occasion to resort to either of these remedies in active cerebral 
congestion, but have employed the bromides with apparent 
benefit in a few stubborn cases, giving them in two or three- 
grain doses every hour. 

Care should be taken in every case to keep the feet warm, 
the head elevated, the chamber cool, and the clothing about 
the chest and neck loose and comfortable. The diet should be 
light and easily digestible; and in all severe cases it should 
be entirely devoid of any stimulating quality. I have found 
nothing better, for this purpose, than a thin broth made of a 
bare knuckle of veal, and containing little more than water and 
gelatine. 

CEREBRAL HEMORRHAGE. 

Synonyms. — Apoplectic Stroke, Cerebral Apoplexy, Apo- 
plexia Sanguinia; Fr., Hemorrhagic Cerebrate Inter stitielle ; Ger., 
Hirnschlag, Schlagfluss, Gehirn-apoplexie, Hirnblutung. 

Definition. — A rupture of a cerebral bloodvessel, and the 
consequent escape of blood into the substance, or into the ven- 
tricular cavities, of the brain. 

Diagnosis. — The distinctive character of cerebral haemor- 
rhage is that of a brain lesion occurring suddenly. But as 
apoplexia sanguinia is but one form of the apoplectic state, it is 
important to distinguish it from the others, namely, the apo- 
plectic variety of cerebral hyperemia, embolism of cerebral 
arteries, alcoholic and uraemic intoxication, sunstroke and 
haemorrhage into the cerebral membranes. 

The distinctive features of cerebral congestion have already 
been given under the head of cerebral hyperemia, which see. 

Embolism of the cerebral arteries may commonly be dis- 
tinguished from cerebral haemorrhage by the fact that in em- 
bolism there are no prodromic symptoms, that the paralysis 
is usually on the right side, and that the disease is almost 
always associated with valvular disease of the heart. 

The symptoms of alcoholic and ursemic intoxication some- 
times closely resemble those of cerebral haemorrhage, but the 
profound stupor of full inebriation can usually be satisfactorily 
determined by the breath, habits and general appearance of 



22 NERVOUS THERAPEUTICS. 

the patient ; while uraemic intoxication offers a sufficient guide 
to the judgment in the existence of kidney disease and the 
chemical and microscopical peculiarities of the urine. 

The insensibility produced by sunstroke can be easily ac- 
counted for by a knowledge of the previous exposure of the 
patient to the direct rays of the sun, while the absence of one- 
sided paralysis clearly distinguishes it from cerebral haemor- 
rhage. 

Haemorrhage into the cerebral membranes may usually be 
distinguished from cerebral haemorrhage by the fact that it is 
seldom followed by hemiplegia, that violent headache is a 
characteristic symptom of it, that coma comes on gradually or 
not at all, and especially by the fact that its course is marked 
by frequent remissions. 

Hysterical coma often closely resembles that of cerebral 
haemorrhage, but in these cases there are usually other evi- 
dences of the hysterical condition present, such as the super- 
ficial character of the symptoms, the unembarrassed state of 
the general circulation, the absence of stertor, the age of the 
patient, the hysterical history and constitution, etc. 

Pathology. — MM. Charcot and Bouchard have conclu- 
sively shown that, in the great majority of cases of cerebral 
haemorrhage, the vascular rupture is due to the formation of 
miliary aneurisms upon the smaller branches of the cerebral 
arteries, in consequence of an inflammatory condition which 
results in atrophy of the middle coat, on which their strength 
chiefly depends. The cerebral bloodvessels are also sometimes 
greatly weakened by atheromatous degeneration, which is a 
common pathological condition in the aged, and is sometimes 
the only known cause of the rupture. Other conditions, like- 
wise, doubtless favor the rupture, such as an increased tension 
of blood in the vessels of the brain; an unhealthy state of 
the blood, such as exists in typhus, scurvy, etc., rendering it 
unfit for the proper nourishment of the bloodvessels, cerebral 
softening, etc. 

Clinical Experience. — Aconite and Belladonna are generally 
given to relieve the earlier and premonitory symptoms, the 
former being preferred when there is much arterial excite- 



CEREBRAL HAEMORRHAGE. 23 

ment, and the Latter when congestion is the most prominent 
symptom. Phosphorus not only retards calcareous degeneration, 
but nourishes the brain substance, thereby lessening the danger 
of vascular rupture, and is given whenever, from hereditary 
predisposition, or tendency to cerebral congestion, an attack 
of sanguineous apoplexy is apprehended. During the attack, 
and until sensibility returns, the chief reliance usually is 
upon Opium, aided, according to the state of the circulation, by 
Aeon ite and Belladonna. At a later period, Arnica, Rhus tox., Nax 
vom. and similar remedies are usually resorted to, partly to 
promote the absorption of the clot, and partly to stimulate the 
nerve centres, and thus relieve the paralytic condition. 

Therapeutic Indications.— Phosphorus. — Probably this is 
the most important remedy, so far as preventive treatment is 
concerned, for the reasons above stated. Hereditary predisposi- 
tion to the disease, a weak condition of the nervous system, the 
existence of senile or scrofulous bronchitis, weak lungs, cough, 
night-sweats and loss of memory, all point to the early use of 
this remedy, especially in the aged, and more particularly if 
subject to transient attacks of cerebral congestion. 

Aconite is another very important remedy, as well in the 
premonitory as in the inflammatory stages. Whenever the 
head is hot, the pulse full, hard and strong, and the patient 
complains of headache, thirst, numbness and formication, this 
remedy is especially indicated. 

Belladonna should follow Aconite, both in the premonitory 
and initial stages of the disease, whenever the symptoms for 
which the latter is given fail to yield, or when the head be- 
comes hot, the eyes red and bloodshot, the pupils contracted, 
the face flushed and the cerebral vessels throb with increased 
violence. Convulsive movements, when spontaneous, are an 
additional indication for this remedy. 

Opium rivals all other remedies during the stage of insensi- 
bility or when the face is dusky red, puffed and a deep coma- 
tose state exists, with stertorous respiration, slow, irregular breath- 
ing, dilated and insensible pupils, face and head covered with 
cold sweat, dropping of the lower jaw and one-sided paralysis. 

Baryta carb. — Sanguineous apoplexy of old people, especially 



24 NERVOUS THERAPEUTICS. 

when accompanied with partial paralysis, the patient being 
unable to speak owing to paralysis of the tongue; anxiety, with 
trembling of the limbs, and an inability to maintain the body 
•in an erect position ; childish, fearful and forgetful. Specially 
suited to those addicted to the excessive use of strong drink. 

Rhus tox. — This remedy may be given with advantage after 
the inflammatory symptoms subside, especially when there is 
a loss of feeling as well as of motion. Rheumatic pains in the un- 
paralyzed side, especially if aggravated by damp weather, also 
point to the use of this remedy. 

Arnica. — Paralysis of the left side of the body, with insensibility 
and stertorous breathing; muttering delirium, with involun- 
tary discharges of faeces and urine; symptoms of shock in old 
people; also suitable for the middle-aged, possessed of strong, 
plethoric constitutions. Arnica stands high as an anti-paralytic 
remedy in these cases, owing to its power of promoting the ab- 
sorption of the clot, or, rather, of the effused blood, whereby 
the clot is contracted and the paralysis correspondingly re- 
lieved. 

Sangninaria. — Attacks due to venous congestion ; distension 
of the temporal veins ; burning heat and redness of the face ; 
burning of the ears ; paralysis of the right side ; bad odor of the 
breath and sputa ; difficult respiration, with pain in the chest, 
and cough. Especially suited to cases complicated with senile 
bronchitis. 

Nux vom. — Sanguineous apoplexy of high livers, professional 
men and those leading a sedentary life ; stertorous breathing, 
stupefaction and paralysis; dropping of the lower maxilla; 
attacks preceded by premonitory symptoms, such as vertigo, 
headache, tinnitus aurium, etc., also for the premonitory 
symptoms themselves. 

Pulsatilla. — Attacks attended by loss of consciousness and 
preceded by drowsiness, especially when occurring in women 
at the climacteric period; or when accompanied or preceded 
by an arrest or disturbance of the menstrual function ; con- 
gested condition of the face, with difficult breathing and pa- 
ralysis. 

Lachesis. — Insensibility, with sopor or drowsiness ; absence 



CEREBRAL HEMORRHAGE. 25 

of mind when conscious; congestion to the head, with blueness 
of the face; slow, heavy, wheezing respiration; full and hard, 
or weak and irregular pulse; paralysis, especially on the left 
side. 

Laurocerasus. — Deep, quiet coma, more like natural sleep 
than usual in such cases; pulse scarcely perceptible; cold, 
clammy skin ; palpitation of the heart ; convulsions, with sub- 
sequent paralysis, including paralysis of the sphincters ; defi- 
cient susceptibility to the action of other remedial agents; 
patient speechless even when conscious. 

Sepia. — Attacks preceded by cerebral hyperemia or by ve- 
nous congestion ; intermitting pulse, cold feet and palpitation 
of the heart ; intense headache coming on suddenly after stop- 
page of the menses. Especially adapted to women at the 
climacteric period, and to men addicted to hard drinking and 
venery. 

Auxiliary Treatment. — Inasmuch as, according to the old 
adage, " an ounce of prevention is worth a pound of cure," 
great care should be taken in all cases where, either from age 
and decrepitude, or from hereditary predisposition, there is 
reason to apprehend an attack of cerebral haemorrhage, to guard 
against its occurrence by a timel} 7 administration of such 
remedies as will tend to improve the blood and strengthen the 
enfeebled capillaries of the brain, such as Phosphorus, Nux vom. 
and Baryta, and also to quiet the circulation and subdue 
any tendency to cerebral hyperemia which may exist by such 
remedial measures as we have recommended under that head. 
(See the preceding section, and for fuller information on this 
important subject the reader may also consult with advantage 
the author's w^ork on Intracranial Diseases, pp. 99-108.) 

After the attack, and especially during the period of uncon- 
sciousness, the patient should be kept in such a position as 
will most favor a return of blood from the head. Thus the 
head and shoulders should be raised by pillows, the clothing 
loosened about the neck and chest, and free ventilation of the 
patient's room at all times secured. The paralyzed limbs 
should be wrapped in cotton batting, or kept warm by means 
of hot flannels, frictions, etc. ; and the bow r els should be relieved 
3 



26 NERVOUS THERAPEUTICS. 

from time to time by emollient or stimulating injections, as 
the exigency of the case may require. Attention should 
also be given to the bladder, and, if necessary, the catheter 
should be used daily until the patient is able to void his 
urine voluntarily. 

The diet is such an important matter that during the early 
stages of the attack nothing more stimulating than gum water, 
barley or rice water, toast water and similar farinaceous drinks 
should be given ; but after the period of inflammatory danger 
is past and improvement commences, more nutritious sub- 
stances may be allowed, such as animal broths, milk, soft- 
boiled eggs, etc., but the effects produced by administering 
such articles of nourishment as these should be carefully 
watched, and if, on strengthening the diet, the face becomes 
flushed, and headache and restlessness or increased stupor en- 
sues, all such stimulating articles of diet should be at once 
withdrawn. If inflammation sets in around the clot, which is 
apt to occur about the ninth or tenth day of the seizure, the 
treatment for meningitis and encephalitis will be required. 

No attempt should be made to overcome the paralysis until 
the period of inflammation is past and the acute symptoms 
have entirely disappeared. Measures may then be safely 
taken for the relief of the paralysis, and for the prevention of 
consecutive muscular contractions. One of the first measures 
to be employed for these purposes is massage, which should be 
administered from one to three times daily by an experienced 
masseur. Some benefit may also be obtained from friction 
with the flesh brush and salt water, or with the electric brushy 
which is still more stimulating. But the most efficient treat- 
ment of the sort is galvanism methodically applied. At first, 
the induced current is to be preferred, but it should be of 
sufficient strength to produce contraction or cause slight pain. 
It may be applied by means of wet sponges to the skin cover- 
ing the muscles, or, if this proves ineffective, it may be applied 
directly to the nerves. Such cases as will not yield to the in- 
duced current, whether they be old or recent, should be treated 
with the primary interrupted current, the primary constant 
current not producing contractions. The same efficient agent 



CEREBRAL THROMBOSIS. 27 

may be used to promote the restoration of sensibility, in cases 
in which the anaesthesia does not spontaneously disappear. 

After the patient has so far recovered as to move about, 
moderate exercise in the open air, change of scenery, salt- 
water baths and a diversified but tranquil life are to be com- 
mended and, as far as possible, secured. 

CEREBRAL THROMBOSIS. 

Synonyms. — Thrombosis of Cerebral Arteries, Veins and 
Sinuses; Fr., Thrombose Cerebrate; Ger., Thrombose Cerebralis, 
Hirnarterienversperrung, Thrombose der Himeirterien. 

Definition. — An occlusion of cerebral arteries, veins or 
sinuses by the coagulation and deposition, in situ, of fibrin 
upon the internal coats, or within the lumen, of the vessels. 

Diagnosis. — The diagnosis of cerebral thrombosis is often 
a matter of extreme difficulty. The disease may be distin- 
guished, in a general way, from cerebral embolism and cerebral 
haemorrhage by the gradual manner of its development ; 
but from cerebral haemorrhage, when, as is sometimes the 
case, the haemorrhage takes place gradually, it can only be 
certainly diagnosed by taking into consideration the predis- 
posing causes, namely, pulmonary affections and valvular 
diseases of the heart. When there is valvular disease, the 
diagnosis between cerebral thrombosis and cerebral embolism 
may be satisfactorily made out by means of the following 
table: 

Cerebral Thrombosis. Cerebral Embolism. 

Advanced age. Youth. 

Evidences of atheroma. Absence of atheroma. 

Fatty degeneration of heart. Previous rheumatic attacks. 

Slight attacks of paresis. Decided paralysis. 



Pathology. — Owing to the diseased condition of the blood- 
vessel its internal coat becomes roughened, which favors the 
deposition of fibrin at that point, The primary layer thus 
formed becomes gradually thickened by fresh accretions, until 



28 NERVOUS THERAPEUTICS. 

finally it fills the whole caliber of the vessel and completely 
obstructs it. While the artery is undergoing occlusion the 
part of the brain to which it is distributed is rendered more or 
less anaemic, and when the vessel becomes entirely closed the 
anaemic parts undergo the process of softening — first, red soft- 
ening (which is probably a state of passive h} T peraemia, com- 
bined with oedema and haemorrhage), and afterwards, unless 
the collateral circulation is speedily and adequately established, 
necro-biotic or yellow softening quickly supervenes. 

Clinical Experience. — As this disease, when fully devel- 
oped, depends upon the presence of foreign matter lying be- 
yond the reach of ordinary remedial agencies, little benefit has 
hitherto been derived from medical treatment; nor can much 
benefit be reasonably expected from such treatment in any 
case, except so far as it may be capable of retarding the pro- 
gress of the disease, and in contributing to the relief of some 
of its most serious and distressing symptoms. How far the 
following plan, prescribed by Dr. Stiles, has proven efficacious 
I have no means of knowing, but that it will palliate such 
cases I have no doubt. 

When the disease shows evidence of inflammatory action, or 
is recent, Bellad., Nux vom., Mercur.; where it is evidently due 
to atheromatous conditions of arteries, Phosphor., Phos. ac. y 
Anac, Zincum ; for hemiplegia, Nux vom., Coccul., Baryta carb., 
Arnica; for vertigo, Iodine (congestive); Sulphur, Digit, (cardiac); 
for sleeplessness, Coffea, Hyosc. or Nux vom., and Chamom., if 
the patient has been addicted to the use of coffee; China, if he 
has been a great tea drinker; for paralysis (general), Phosphor. , 
Conium, Coccul. (local), Caustic, Aeon., Ignat., Bellad. ; for con- 
vulsions (simulating epilepsy), Bellad., Cede, carb., Cuprum,. 
Strychnine; for emotional disturbances, Ignat. ; headache (ac- 
tive), Aeon., Bellad., Bryon., Nux vom., Glonoin; (passive), 
Getsem., Opium; for imbecility, Arnica, Ambra, Selen., Sepia; 
or sensation of formication, Secale. 

Therapeutic Indications. — These, so far as applicable to 
the disturbances caused by cerebral thrombosis, may be found 
under the respective heads of cerebral ansemia, cerebral hypersemia y 
cerebral haemorrhage, and encephalitis, which see. 



CEREBRAL THROMBOSIS. 29 

Auxiliary Treatment. — This consists for the most part (1) 
in the removal, so far as possible, of all debilitating causes and 
disturbances; (2) in aiding both the general and local circula- 
tion by such constitutional and other means as the exigencies 
of the case may require; and (3) in endeavoring to dissolve 
the fibrinous deposit by the administration of alkaline solvents. 

Dr. B. W. Richardson, after citing a number of illustrative 
cases, formulates the following rules, among others, for the 
exhibition of Ammonia as a solvent of fibrinous concretions in 
the heart and bloodvessels: 

1. The ammonia is best administered either in the form of 
the strong aqueous solution, or of the saturated alcoholic solu- 
tion. More than five minims at a time cannot easity be swal- 
lowed. The best menstruum for the ammonia is milk, and if 
the milk be chilled by ice, the patient takes the mixture with 
great facility. 

2. The ammonia must be relied upon exclusively. Seda- 
tives and stimulants of all kinds are to be avoided as fraught 
with danger. Wines and spirits are most injurious; they pro- 
duce a danger of movement of the fibrinous mass; they excite 
and, in time, exhaust the heart. 

3. The diet should be, as nearly as possible, of pure milk, 
with an occasional change to gravy soup or minced codfish, 
with bread or toast. Other solid substances do not digest 
readily; they create flatulency, and cause a restless movement 
of the body, which is detrimental. 

4. With the medicinal and dietetic treatment thus enjoined 
there must be combined the most perfect rest of the body in 
one position. The secret of success consists in producing solu- 
tion of the obstructing mass while it lies sufficiently out of the 
course of the circulation. If it loosen from its hold while it 
remains semi-solid, however small it may be, it will be a source 
of additional danger. 

5. Together with this physical rest, every mental comfort 
must be supplied. The patient must be harassed with no 
unnecessary fears, agitated by no unnecessary comments. 
Much of the success of the treatment depends on the gentle 
firmness with which the practitioner enforces that the greatest 



30 NERVOUS THERAPEUTICS. 

advantage is secured by absolute repose of the mind as well as 
the body. 

6. When the secondary changes indicate the solution and 
distribution of the fibrin, the administration of the ammonia 
is not to be immediately withdrawn. The alkali is still as im- 
portant, under these circumstances, as in those which precede 
them. 

7. The conditions warranting the withdrawal of the solvent 
are: relief of venous engorgement; normal return of pulse and 
temperature, and restored mental and physical power; in other 
words, a complete restoration of all the normal powers and 
functions. When these favorable conditions exist, it is fair to 
infer that no obstruction remains in the circulatory canals, 
and that the ammonia may be safely withdrawn. 

But inasmuch as the ammonia, however far it may, with 
reason, be carried, does no injury that is not quickly recovered 
from, there exists no cause for hurry in withdrawing it. It 
may, therefore, be continued in less frequent doses for a few 
days after every danger appears tp have passed away. 

The above directions have been formulated w T ith reference, 
more especially, to embolism and thrombosis of the larger 
circulatory vessels, but they apply equally well to the same 
conditions of the capillary vessels of the brain, except that, in 
the latter case, the injunctions as to absolute rest need not be 
insisted on to so great an extent. Nevertheless, it is important 
even in these cases that the complete solution of the fibrinous 
obstructions should take place in situ, unless the general 
health of the patient should materially suffer from the confine- 
ment; hence it is best to have them rigidly observed in every 
case of cerebral vascular obstruction in which the treatment 
may be tried. 

CEREBRAL EMBOLISM. 

Synonyms. — Embolism of the Cerebral Arteries and Capil- 
laries; Ft., Embolie Cerebrale; Ger., Embolie Cerebralis, Hirn- 
arterienverspemmg, Embolie der Hirnarterien. 

Definition. — The obstruction of arteries or capillaries of 
the brain by solid particles of matter formed in other parts of 



( BJREBRAL EMBOLISM. 31 

the body, and carried along in the course of the circulation to 
points where they have become lodged. 

Diagnosis. — Occlusion of the left middle cerebral artery 
causes right hemiplegia with aphasia, while obstruction of the 
right middle cerebral produces left hemiplegia without aphasia. 
Embolism of the ophthalmic artery gives rise to sudden am- 
aurosis; and sudden plugging of the basilar artery produces 
vomiting. These diagnostic points are sufficient, in connection 
with the other symptoms mentioned below, to clear up the 
majority of cases of cerebral embolism; but when the symp- 
toms of apoplexy are present it may not be possible at 'first to 
distinguish the disease with certainty from cerebral haemor- 
rhage. When, however, the paralysis vanishes suddenly, we 
know that it was not caused by cerebral haemorrhage; and if 
recovery takes place within two or three days after the attack, 
the latter can only be referred to an embolus. Moreover, there 
are no premonitory symptoms in embolus; the disease occurs 
irrespective of age ; the paralysis, which is usually on the right 
side, is generally combined with aphasia; and the disease is 
almost always associated with valvular disease of the heart, or 
a preceding attack of endocarditis. The differential diagnosis 
between cerebral embolism and cerebral thrombosis may be 
found under the latter head. 

Pathology. — Many competent observers have shown that 
the cerebral bloodvessels may be obstructed by fibrinous con- 
cretions derived from the heart or large vessels; that this 
obstruction produces anaemia of those portions of the brain to 
which the affected artery is distributed; and that unless the 
obstruction is quickly removed, or the collateral circulation 
adequately and speedily established, softening of the brain 
substance is sure to follow. 

Anomalous cases of cerebral embolism sometimes occur, in 
which general fever takes the place of hemiplegia or other 
local paralysis. These cases are characterized by high fever, 
with delirium, and without any, or scarcely any, definite pa- 
ralysis or aphasia. The pathological condition consists in the 
distribution through the, brain of embolic dust, so fine as to 
traverse without hindrance the larger arteries of the base and 



32 NERVOUS THERAPEUTICS. 

substance of the brain, to be finally arrested in the minute 
channels of the pi a mater. 

Clinical Experience. — The only clinical experience worth 
mentioning is that referred to under the head of thrombosis, 
which see. 

Therapeutic Indications. — As these have to do with effects 
rather than causes, they will be found given in detail under 
their appropriate headings. See cerebral ansemia, hyperemia, 
haemorrhage and softening. 

Auxiliary Treatment. — This is necessarily limited to such 
measures as are calculated to favor the establishment of the 
collateral circulation, to wit: lowering or raising the head, ac- 
cording as the cerebral circulation is more or less embarrassed; 
promoting the general circulation by friction with the flesh 
brush, wrapping the body and limbs in warm blankets, cotton 
batting, etc., in case the patient is somnolent and the bodily 
temperature much reduced; and, finally, by a cautious en- 
deavor to dissolve away the fibrinous concretions by the 
"ammonia" treatment already described. (See p. 29.) 

ENCEPHALITIS. 

Synonyms. — Suppurative Inflammation of the Brain, Cere- 
bri tis; Fr., Inflammation ole VEncephale; Ger., Enkephalentzicn- 
dung; — Cerebral Abscess; Fr., Abces Cerebrate, Abces de VEnce- 
phale; Ger., Eiterbeule des Gehirns, Himgeschwur. 

Definition. — Partial inflammation of the brain substance, 
usually complicated with meningitis, and tending to sup- 
puration. 

Diagnosis. — The diseases for which encephalitis is liable to 
be mistaken are: acute cerebral meningitis, cerebral haemor- 
rhage, cerebral tumors, and the disease called general paralysis. 
In acute meningitis the fever is much higher, the convulsive 
movements more general, the headache more severe, and the 
delirium more marked and constant. In cerebral haemorrhage 
the symptoms generally become more and more ameliorated 
as {he disease progresses, whereas in encephalitis they become 
progressively more pronounced. The symptoms which charac- 



ENCEPHALITIS. 33 

terize general paralysis, and also those which attend the de- 
velopment of cerebral abscesses, closely resemble those which 
accompany the growth of cerebral tumors, and can, as a rule, 
only be distinguished by the history of the case and the fact 
that encephalitis is usually of shorter duration than general 
paralysis, and is not marked by the "mania de grandeur" 
peculiar to the latter disease. 

Pathology. — The tendency to suppuration is so great in 
this disease that more or less softening of the brain substance 
is always found after death, generally in circumscribed patches, 
which usually terminate in one or more abscesses, involving 
not only the gray matter, in which the inflammatory process 
usually commences, but also the white substance of the cere- 
brum, the basal ganglia, and, in some cases, the cerebellum. 

In acute cases, the abscess, being surrounded by no limiting 
capsule, encroaches more and more upon the adjacent tissues, 
and may ultimately reach the surface of the brain, or break 
through into the lateral ventricles. When the inflammation 
is due to injury or caries of the cranial bones, it is no uncom- 
mon thing for it to escape, sooner or later, through the ear or 
nose. On the other hand, w 7 hen the inflammatory process is 
more chronic, the abscess is surrounded by a membranous 
capsule composed of connective tissue, and if large w T ill give 
rise to symptoms of compression. There is no hope of recovery 
after the disease has passed the stage of red softening. 

Clinical Experience. — Our clinical experience in this dis- 
ease is so mixed up with that of acute meningitis, with which 
it is commonly associated, that no reliable distinction can be 
made between them. This, however, is of but little conse- 
quence in a practical point of view, as the treatment of sup- 
purative encephalitis is, so far as our present experience goes, 
altogether palliative. It is right to add, however, that Kafka ap- 
pears to have treated a case successfully with Arsenicum, " even 
when cerebral softening, with progressive increase of the mor- 
bid phenomena, coexisted side by side with the symptoms of 
cerebral hyperemia/' the remedy having been employed after 
the hypersemic condition had been relieved by Glonoin and 
Belladonna. Kali brom. and Cannabis ind. have proved bene- 



34 NERVOUS THERAPEUTICS. 

ficial in some cases by diminishing the irritability of the 
nervous system. 

Therapeutic Indications.— Considering, as we do, that the 
curative stage of this disease is limited to the initial or hyper- 
semic period, to detail the therapeutic indications would be 
but to repeat what is said under that head regarding cerebral 
hyperemia and meningitis. We will simply add that Iodine 
and Plumbum have been recommended, chiefly on theoretical 
grounds, the former for its supposed power to control suppu- 
rative inflammation, and the latter for its anti-paralytic action ; 
Mercurius iod. in syphilitic and scrofulous subjects, especially 
when there is a history of chronic otorrhcea, enlarged tonsils or 
rheumatism, with an aggravation of the symptoms at night or 
from a change of weather ; Pulsatilla, when the disease follows 
the suppression of an eruption or of a chronic discharge from 
the ear; Silicea, when an abscess is supposed to have formed; 
and Zincum in the later stages, when there is great depression 
of both mind and body. 

Auxiliary Treatment. — Hygienic measures, if instituted 
sufficiently early, may be of service in warding off an attack. 
Hence, in all suspicious cases, especially if the patient is weak, 
scrofulous or ill-nourished, a good nutritious diet should be 
recommended, and, where vertigo does not prevent, the patient 
should exercise freely in the open air, live in a mild, equable 
climate, and, if practicable, occasionally take an ocean voyage 
— all of which will strongly tend, by invigorating the system, 
to remedy any threatened invasion of the disease. 

CEREBRAL SOFTENING. 

Synonyms. — Softening of the Brain ; Fr., Ramollissement 
Cerebrate; Ger., Emveichung des Gehirns. 

Definition. — A necro-biotic process, involving brain tissue, 
caused by defective nutrition, depending in most cases on vas- 
cular obstruction and attended by diminished consistence. 

Pathology. — When obstruction in any of the cerebral blood- 
vessels takes place on the far side of the circle of Willis, necro- 
biosis is quickly established, because there is no free vascular 



CEREBRAL SOFTENING. 35 

connection by which a collateral circulation can be speedily 
effected. Hence the parts supplied by the obstructed vessels 
at once become anaemic, and, nutrition being cut off, a condi- 
tion known as red softening, i.e., hyperemia, with cedematous 
swelling and haemorrhage, soon supervenes. Subsequently, 
the color, which is due entirely to the extravasation of red 
corpuscles, gradually fades, and in a few weeks the affected 
tissues present the appearance of yellow softening. In case the 
patient survives a sufficient length of time white softening is 
produced, the cerebral matter changing into milk-like emul- 
sion, part of which eventually becomes absorbed, leaving in 
some cases a cyst partially filled with liquid, resembling the 
cysts found after ordinary attacks of cerebral haemorrhage. 

There is another condition, called primary yellow softening, 
in which the parts immediately undergo fatty degeneration, 
without the previous changes above mentioned. This is sup- 
posed to depend upon a weakened state of the heart, the blood 
coagulating so quickly in the sphere of the obliterated vessel 
as to prevent any reflux of blood through the corresponding 
vein. 

Clinical Experience. — Belladonna, Kaliphos., Rhus tox., Glo- 
noin, Picric ac. and Arsenicum have all been given with apparent 
success in this disease — I say, with apparent success, because I 
do not believe it to be within the power of any remedy to 
effect a cure after the stage of red softening has passed, even 
though the vascular obstruction should have ceased. Up to 
and including this stage, however, these remedies have given 
good results ; indeed, more or less amelioration of the symptoms 
has been produced by them at a comparatively late period in 
the disease. So far as the pathological condition of the brain 
is concerned, Arsenicum and Picric ac. are eminently homoeo- 
pathic to it, and if it be possible to set up a curative action in 
the affected tissues at this stage of the disease, these are the 
remedies most likely to prove successful. 

Therapeutic Indications. — Picric ac. — Necro-biotic soften- 
ing of nervous tissue; intense cerebral hyperemia; bleeding of 
the nose; cerebral softening; extremities feel heavy, cold and 
very weak; speedy exhaustion from slight exertion; general 
state of asthenia. 



36 NERVOUS THERAPEUTICS. 

Arsenicum. — Necro-biotic softening; headache, vertigo, wan- 
dering pains, impaired sensibility of the limbs, delirium, coma, 
lassitude, nervous debility, cramps, trembling, paralysis. 

Strychnia. — Cerebral softening, accompanied by hemiplegia, 
or by general paralysis. 

Zincum phos. — Severe headache, dizziness, sleeplessness, loss of 
memory, cardiac weakness; general debility. 

Belladonna. — Fixed headache, with drowsiness, vertigo and 
loss of memory; convulsions; local paralysis. 

Abrotanum. — Gloomy, despondent, irritable, ill-natured ; brain 
easily fatigued; head weak; face pale and wrinkled; indolent 
and averse to physical exercise. 

Auxiliary Treatment. — As embolism and thrombosis are 
the two principal causes of cerebral softening, the auxiliary, 
no less than the special, treatment recommended for those 
conditions applies with equal force to this disease, and need 
not therefore be repeated. The same is true of the treatment 
recommended for cerebral hyperemia and haemorrhage, con- 
ditions which belong especially to the curative stage of this 
affection. Indeed, it is only by directing the treatment in this 
way against individual symptoms and conditions that we can 
stand any chance of curing, or even of greatly ameliorating, 
the cerebral disorder. 

From what has been said regarding the aetiology and path- 
ology of cerebral softening, it follows that any influence or 
treatment calculated to low r er the tone of the system, no matter 
what it may be, must have a prejudicial effect, and consequently 
that the early adoption and steady use of supporting measures 
are of the highest importance. If the general circulation is 
much embarrassed, or if the patient is much reduced in strength 
or his mind greatly impaired, he should be kept in a quiet, 
recumbent position, the body and extremities kept warm by 
artificial heat, friction, etc., and all intellectual exertion and 
every form of mental and bodily excitement should be care- 
fullv avoided. 



APHASIA. 37 



APHASIA. 



Synonyms. — Loss of the Faculty of Speech, Aphemia, 
Alalia: jFV"., Aphasie; Ger. f Sprachldhmung, Aphasie. 

Definition. — A disease of the brain attended by a loss of 
memory of words, or of the ability to express them in written 
or articulate language. 

Diagnosis. — This disease is easily recognized, as there is no 
other affection with which it is liable to be confounded. When 
due to cerebral haemorrhage, thrombosis, embolism, abscess or 
tumor, it is almost invariably associated with right-sided hemi- 
plegia ; but in simple cases, such as are caused by mere func- 
tional derangement, irritation, oedema, congestion, etc., there 
is little or no attending paralysis, and the prognosis is far 
more favorable. 

Pathology. — Broca first made the discovery that the cere- 
bral centre for articulate language is in the third left frontal 
convolution of the brain, along the course of the middle cere-, 
bral artery in the island of Eeil ; and that irritation or injury 
of this portion of the cerebrum causes aphasia. This discovery 
has since been abundantly confirmed by numerous post-mortem 
examinations, from which it appears that the disease is 
usually due, in fatal cases, to the blocking up of the left mid- 
dle cerebral artery by an embolus or thrombus. 

Clinical Experience. — Notwithstanding the fact that apha- 
sia is often due to occlusion of the middle cerebral artery, it is 
a singular fact that many cases of the disease have yielded to 
homoeopathic treatment ; from which we infer that, contrary 
to the usual belief, aphasia results far more frequently from 
irritation or congestion than from organic disease. Decided 
improvement and, in many cases, satisfactory cures have been 
reported from the use of Belladonna, Arnica, Stramonium, Plios- 
phorus, Glonoin, Baryta, Lachesis, Kali brom., Causticum, Lyco- 
podium, Zincum, Conium and Bothrops. 

Therapeutic Indications. — Lycopodium. — Makes many mis- 
takes in reading and writing; uses wrong words, and words 
which do not express what he wants to say; mixes up letters 
and syllables, and leaves out part of them; is very forgetful, 
and troubled by confusion of thought. 



38 NERVOUS THERAPEUTICS. 

Stramonium. — Talks at random, using a perfect diarrhoea of 
words without rational meaning; confusion of intellect, with 
great weariness of mind; congestion of the brain, with con- 
tracted pupils, and almost complete blindness; stuttering; 
paralysis of the organs of speech; loss of memory; unconscious- 
ness; extreme insensibility of all the senses. 

Conium. — Very forgetful, especially of words; cannot under- 
stand what he is reading; uses wrong words in speaking; loss 
of memory, with great confusion of mind; entire loss of the 
power of speech; hesitating and difficult speech ; somnolence, 
amounting to stupefaction.. 

Arnica. — Aphasic symptoms following an attack of cerebral 
haemorrhage; stertorous breathing; bruised, aching feeling in 
the brain ; paralysis. 

Grlonoin. — Loss of memory for words and of the power of 
expressing them ; acute congestion of the brain ; mental torpor. 

Baryta carb. — Loss of memory for words and names; cannot 
recollect the names of persons or things; great dulness of 
mind and of the senses. 

Lachesis. — Dulness of comprehension; does not understand 
what he reads or hears; loses the sense of words; makes mis- 
takes in writing; confuses numbers and dates; absence of 
thought, with great weakness of memory. 

Kali iod. — In syphilitic and epileptic cases; also when the 
aphasic symptoms have been preceded by an attack of cerebral 
haemorrhage. 

Phosphorus. — In cases where the symptoms preceding the 
attack show general depression of the nervous system, as mani- 
fested by weakness, mental torpor, restlessness and indecision. 

Causticum. — Great weakness of memory; very forgetful of 
words and names; head feels heavy and dull; absentmind- 
ness; congestion of the brain; inability to think clearly on 
any subject. 

Colchicum. — Inability to pronounce words correctly; loss of 
memory for words; leaves out words and syllables in writing; 
confusion of thought. 

Chamomilla. — Omits words in speaking and writing; is very 
forgetful and absentminded ; great dulness of comprehension; 
mental vacuity; stammering hesitancy of speech. 



CEREBRAL BYPERTROPHY. 39 

There are many other remedies the pathogeneses of which 
contain aphasic symptoms, among which are: Olean., Thuja, 
Anac, Graph., Ign., Natr. mnr., China, Rhodod., Crocus, Arg. 
nit., Hepar sulph., Merc, Puis., Nux vom., Nux mosch. ; others, 
like Opium, GEnan., Bell., are eminently suited to apoplectic 
conditions; Hyosc, Bovis., Phos. ac, Cocc, Alum., Plat., when 
absentminded and forgetful ; Sulph. ac, A mm. carb., Sepia, Bow, 
awkwardness of expression. 

Auxiliary Treatment. — Prof. Charcot has attempted to 
show that the power to pronounce or to write words depends 
upon an impression made upon the ear or eye, and therefore 
that every aphasia or agraphia is a word amnesia situated in 
some central ganglion of the brain, instead of being confined, 
as is generally thought, to Broca's convolution. If Charcot's 
doctrine is correct, then much may be done in chronic cases 
towards recovering the faculty of speech, by educating, so to 
speak, the corresponding sense centre. We know that some- 
thing like this has already been accomplished in a number of 
instances, but it has generally been referred to the "unedu- 
cated" third frontal convolution of the opposite side of the 
brain, namely, the right. May it not be possible, in these 
cases, by careful practice every day, to so educate the previously 
unused sense centres presiding over the faculty of speech, as to 
greatly favor a cure, and in time, perhaps, overcome the 
difficulty altogether? 

CEREBRAL HYPERTROPHY. 

Synonyms. — Hypertrophy of the Brain, Hyperplasia of the 
Cerebral Neuroglia, Hypertrophia Cerebri ; Fr., Hypertrophic 
Cerebrale, Hypertrophic du Cerveau; Ger., Hypertrophic des 
Gehirns, Gehirn-Jiypertrophie. ► 

Definition. — An overgrowth or hypertrophy, not of the 
nervous tissue, but of the neuroglia, or interstitial connective 
tissue of the brain. 

Diagnosis. — In congenital cases, owing to the enlargement 
of the head, the disease is liable to be mistaken for chronic 
hydrocephalus; but children affected with cerebral hyper- 



40 NERVOUS THERAPEUTICS. 

trophy are mentally brighter and more precocious than usual, 
while the subjects of hydrocephalus are unusually dull and 
stupid. In other cases the diagnosis is more or less uncertain, 
but when the enlargement is attended with frequent attacks 
resembling epilepsy, its existence is highly probable. 

Pathology. — On exposing the surface of the brain in situ, 
it immediately expands so as to overlap the bones of the 
cranium ; but a careful examination shows that while there is 
no undue amount of cerebral matter present, there is an ex- 
cessive development of the neuroglia, rendering the brain 
heavier, firmer and more elastic than the normal organ. 

Clinical Experience. — It is not certain that the disease 
has ever been materially benefited by medical treatment. 
Calcarea carb., Phosphorus, Kali iod., and a few other reme- 
dies have been recommended, but only, I believe, on theoreti- 
cal grounds. 

Therapeutic Indications. — These pertain, almost exclu- 
sively, to the remedies usually employed in cerebral hypersemia, 
convulsions, epilepsy and cerebral paralysis, and will therefore be 
found under those headings. 

Auxiliary Treatment. — The most important accessory 
treatment in these cases consists in improving the general 
health, guarding against exposure to all injurious influences, 
relieving cerebral congestion when present, and abstaining 
entirely from the use of alcoholic stimulants. 

CEREBRAL ATROPHY. 

Synonyms. — Atrophy of the Brain, Atrophia Cerebri, Dif- 
fused Cerebral Sclerosis; Fr., Atropine Cerebrate, Atrophic du 
Cerveau; Ger., Atropine des Gehirns, Gehirn-atrophie. 

Definition. — A shrinkage or wasting of the brain, with or 
without attending degenerative changes. 

Diagnosis. — Congenital cases are, as a rule, easily recogniz- 
able, as they constitute various grades of idiocy; but partial 
cerebral atrophy, which is usually due to local lesions, such as 
haemorrhage, softening and encephalitis, and general cerebral 
atrophy, which occurs mostly in the aged, and is attended with 



CEREBRAL ATROPHY. 41 

a gradual loss of cerebral power, can only be conjecturally 
determined during life, and that most satisfactorily by the 
history of the case. 

Pathology. — In simple, that is to say, in primary or un- 
complicated cases, the brain is simply diminished in volume, 
owing to a contraction or shrinkage of its constituent elements, 
the cerebral cells, nerve tubes and arteries being all more or 
less contracted. 

In the secondary variety, the neuroglia, or connective tissue 
element, becomes atrophied or sclerosed, producing a shrinkage 
of the convolutions, so that in some places they are widely 
separated; the ventricles and subarachnoid space contain a 
large amount of serum; and in some cases portions of the 
brain tissue undergo softening, apparently from inflammatory 
action, as the membranes are thickened and opaque. 

Clinical Experience. — This has reference exclusively to 
the physical, mental and nervous weakness experienced in 
these cases, as the atrophy itself cannot, of course, be remedied. 
The different salts of Baryta appear to have ameliorated the 
symptoms to a greater degree than any other remedies which 
have been tried. 

Therapeutic Indications. — These are such as pertain to 
the various lesions associated with the disease and their char- 
acteristic symptoms. As they may possibly be of some service 
in suggesting palliative treatment in certain cases, the reader 
will do well to consult the indications given under the several 
heads of cerebral haemorrhage, encephalitis, cerebral paralysis, con- 
vulsions and epilepsy. 

Auxiliary Treatment, — It is claimed that galvanism has 
been employed with occasional benefit in these cases, by pro- 
moting the nutrition of the atrophied cells. I have myself 
seen the paralysis diminish, the contractions relax, the mind 
improve and the wasted limbs gradually increase in size and 
strength under its stimulating influence. 

Both the induced and primary currents may be required, 

the interrupted secondary current being best for the paralysis, 

and the constant current for the relaxation of contractions. 

Ten Leclanche cells will generally furnish a current of suffi- 

4 



42 NERVOUS THERAPEUTICS. 

cient intensity, the sponges being applied just behind the ears 
every second or third day, for a period not exceeding four or 
five minutes at one sitting. 

Such hygienic measures should be adopted as are best calcu- 
lated to improve the general health of the patient, since what- 
ever improves the health also improves nutrition. 

MULTIPLE CEREBRAL SCLEROSIS. 

Synonyms. — Primary Multiple Sclerosis, Disseminated, 
Insular, Multilocular, or Idiopathic Cerebral Sclerosis; Ft., 
Sclerose en Plaques Disseminees ; Ger., Multiple SMerose des Ge- 
hirns. 

Definition. — A cerebral lesion, consisting of plates or no- 
dules of sclerosed tissue scattered throughout the substance of 
the brain. 

Diagnosis. — Primary multiple sclerosis is liable to be mis- 
taken for paralysis agitans; but in the latter disease there are 
no head symptoms, no muscular incoordination, no inability 
to trace a straight line with the dynamograph, no muscular 
anaesthesia, no abnormal states of sensibility, and is more apt 
to occur before than after fifty years of age. Secondary or as- 
cending multiple sclerosis may generally be distinguished by 
the fact that the tremor precedes the paralysis, and also by the 
fact that the trembling is associated with voluntary as well as 
with involuntary muscular movements. Chorea may be dis- 
tinguished from multiple sclerosis, not only by the history of 
the case, but by the facts that it usually occurs in' young 
people, has no head symptoms, nor any actual tremor, the dis- 
orderly movements being simply more marked degrees of in- 
coordination, which render the movements more irregular^md 
pronounced. 

Pathology. — The patches of sclerosed tissue are not confined 
to the hemispheres, though the cerebrum is their usual seat ; 
they are occasionally found at the same time in the medulla, 
the pons and the cerebellum. Whether these cases are really 
different, as Hammond and others contend, from those in 
which the spinal cord is also implicated, is by no means cer- 



MULTIPLE CEREBRAL SCLEROSIS. 43 

tain. We know that multiple sclerosis is progressive, and we 
also know that in many cases the spinal form is secondary to 
that of the brain; but it does not follow that it is always so, 
nor that the disease, in such cases, is always an independent 
affection. What appears to be established is that, when con- 
fined to the encephalen, it gives rise to symptoms sufficiently 
characteristic to entitle it to be regarded as a distinct disease. 

Clinical Experience. — Argentum nit. and Oxalic ac. stand 
at the head of the list in the treatment of this disease. Good 
results have also been obtained from Plumbum, Baryta, Zincum, 
Tarantula, Phosphorus, Sulphur and Rhus tox. 

Therapeutic Indications. — Oxalic ac. — Lancinating pains 
like electric flashes in different parts of the body ; electric-like 
pains in the forehead and vertex ; sclerosis of nerve-tissue ; tremor 
of the limbs; numbness of the fingers and toes. 

Argentum nit. — Sharp, darting pains in the head, body and 
limbs; paralytic weakness in the back and limbs ; trembling of 
the limbs; sensation of an epileptic aura; tremor increased by 
emotional excitement; tingling, followed by numbness in the 
hands and feet. 

Plumbum. — Tearing, shooting pains from occiput to forehead ; 
paralytic weakness of the extremities, most marked upon the 
right side; atrophy of the muscular tissue, especially when 
arising from sclerosis of the cerebro-spinal system; trembling of 
the limbs; excessive pains in the limbs. 

Baryta carb. — Trembling of the hands and limbs, especially in 
old people; great bodily and mental weakness; facial paralysis ; 
tremor of the feet when standing; arms heavy and tremulous; 
numbness and tingling in the fingers ; shooting pains deep in 
the brain. 

Zincum oxyd. — Jerking and trembling of the limbs; remark- 
able sinking of strength; paralytic weakness of the limbs, wdiich 
tremble violently; tingling numbness in the limbs; painful ten- 
sion in the muscles when in action. 

Tarantula. — Chorea-like movements in the limbs; extreme 
restlessness; numbness of the trunk and limbs ; paralysis. 

Phosphorus. — Cerebral paralysis; tearing pains in the fore- 
head and temples; numbness and formication in the limbs ; 



44 NERVOUS THERAPEUTICS. 

tremor of the hands; great restlessness and weakness; sensation 
as if completely paralysed. 

Sulphur. — Tremor of the hands; unsteady gait; tearing pains 
through the head, body and limbs; great debility and trembling; 
numbness and formication. 

Rhus tox. — Cerebral paralysis; trembling of the limbs ; twitch- 
ing of individual muscles; numbness, both general and local; 
wavering sensation in the brain, especially when in motion ; 
lacerating pains in the head, especially when stooping; aggra- 
vation of the symptoms during damp weather or just before a 
storm. 

Consult, also, the indications given under the head of cerebral 
paralysis, where a number of other remedies, of greater or less 
value in this disease, may be found. 

Auxiliary Treatment. — What is said under this heading 
concerning cerebral atrophy applies with equal force to multiple 
sclerosis. This is especially true regarding galvanism, and yet 
it cannot be doubted that, as a rule, electricity, in the indis- 
criminate way in which it is frequently used, has done almost 
as much harm as good. Overstimulation of any organ, espe- 
cially when its functional activity is impaired by organic dis- 
ease, is always more or less harmful, and this is emphatically 
true of the brain. Extreme care, therefore, should be taken 
whenever this potent remedy is employed in multiple cerebral 
sclerosis. 

ATHETOSIS. 

Synonyms. — Hammond's Athetosis; Fr., Athetose; Ger., 
Athetose. 

Definition. — A condition characterized by a slow, steady 
movement of the fingers and toes, and by an inability to re- 
tain them in any one position. 

Diagnosis. — The disease is liable to be mistaken for post- 
hemiplegic chorea; but the movements in this variety of 
chorea are quick, irregular, jerky and variable, while in athe- 
tosis they are slow, systematic and uniform. 

Pathology. — By some, athetosis is regarded as a symptom 
rather than a disease, as the cases so far observed are mostly 



CEREBRAL SYPHILIS. 45 

found to be associated with some other nervous affection, such 
as hemiplegia, chorea and cerebral embolism ; but as these all 
depend upon brain lesions, and, moreover, as bilateral athe- 
tosis often occurs in idiotic children, the affection in question 
is, I think, justly entitled to be regarded as a distinct disease. 
Its seat appears to be chiefly in, and just exterior to, the cen- 
tral cerebral ganglia — the corpus strictum and optic thalamus. 

Clinical Experience. — Cannabis ind., Arsenicum and Agari- 
cus have been credited with curative powers over this disease, 
and from its resemblance, in some cases, to chorea, it is not 
improbable that, when the central ganglia of the brain are in 
a state of irritation simply, these remedies may prove effective. 

Therapeutic Indications. — The cerebral symptoms in this 
disease being similar to those given under cerebral hsemorrhage, 
chorea, epilepsy, cerebral embolism and paralysis, the appropriate 
therapeutic indications may be found under those headings. 

Auxiliary Treatment. — Everything calculated to lessen 
irritation and build up the system is likely to be of service ; 
hence good nutritious food and an abundance of fresh air 
are of prime importance. Where the intellect is impaired, as 
in the case of idiotic children, moral treatment may be neces- 
sary. Most patients in this condition have strong imitative 
faculties, and these may often be turned to good account. 

The primary galvanic current is reported to have been success- 
ful in stopping the movements after several months' contin- 
uous treatment. The positive pole may be placed over the 
spine or brachial plexus, and the negative on the affected 
muscles. 

CEREBRAL SYPHILIS. 

Synonyms. — Syphilitic Disease of the Brain, Cerebral 
Syphiloma, Gumma Syphiliticum Cerebri ; Fr., Syphilis du 
Cerveau; Ger., Hirnlustseuche, Syphilitische Gehirn-Erkrankung. 

Definition. — Specific lesions of the brain and its membranes, 
congestive, vascular and gummatous, due to secondary and 
tertiary syphilis, especially the latter. 

Diagnosis. — First in the order of importance is the his- 
tory of the case, which is often sufficient of itself to clear 



46 NERVOUS THERAPEUTICS. 

up the diagnosis; next, as pointed out by Brown-Sequard, 
the disorderly grouping of nervous phenomena should lead 
us to interrogate syphilis as a cause, as, for example, pa- 
ralysis of some muscle of the eye and paraplegia, or pa- 
ralysis of one hand and the other foot, etc. Age is also of 
great diagnostic importance, as paralysis occurring in youth- 
ful persons is, in the great majority of cases, of syphilitic 
origin. Violent paroxysmal headache is another character- 
istic symptom of the disease; there is no form of headache so 
intense as that which results from syphiloma of the dura mater. 

In case the patient has no clear syphilitic history, the differ- 
ence, which is often quite marked, between the real and appar- 
ent age, the facial expression, and especially the ophthalmos- 
copic symptoms are usually sufficient to establish the diagnosis 
beyond a doubt. The most reliable ophthalmoscopic symp- 
toms are: swelling, hyperemia and oedema of the papilla, vari- 
cosity of the veins, and a peculiar form of neuro-retinitis and 
choroiditis known as syphilitic. 

Pathology. — The essential, gross pathological features of 
cerebral syphilis, according to Dr. Dowse, include (a) inflam- 
matory thickening of the membranes, which may originate in 
the lining membrane of the osseous system with which the nerv- 
ous structures come into contact; (6) invasions of the neuro- 
glia by a diffuse form of gummatous infiltration, which may 
be the result, primarily, of disease of the circulatory system; 
and (c) the appearance of syphilomatous masses, usually located 
in the upper convolutions of the anterior lobes, and almost 
invariably at the cortex, closely united to the membranes, 
extending into the surrounding tissue, which is generally 
softened, hypervascular and of a faint yellow color; the nerve 
cells and vessels giving evidence, under the microscope, of 
degenerations resulting from vascular obstruction. 

Clinical Experience. — The cardinal treatment for cerebral 
syphilis, as for syphilitic diseases generally, is Mercurius and 
Kali iod., in large doses. It is no use to speculate as to their 
homceopathicity, or anything of that sort ; the fact stands out 
prominently in the experience of every school that the best 
and most reliable remedies for syphilitic affections, whatever 



CEREBRAL SYPHILIS. 47 

may be their seat, character, form or history, are large and 
frequently repeated doses of these two remedies. It is useless, 
therefore, and often worse than useless, to waste time in seeking 
other remedies for this disease in any given ease until these 
hare been fairly tried and failed. If experience is worth anything 
as a guide to treatment, we have it here. 

Therapeutic Indications. — Mercurius. — This is our sheet- 
anchor in the secondary forms of cerebral syphilis, that is, 
when associated, as is sometimes the case, with syphilitic 
exanthems, or other varieties of secondary syphilitic manifes- 
tations; mental and bodily anguish, with great restlessness 
and complete insomnia; pain deep in the head, setting the 
patient almost crazy; wishes he was dead. 

Kali iod. — Best and most reliable remedy for the tertiary 
form of the disease, or when there are no other symptoms of 
the disease present than what is manifested in and by the 
nervous system; also in cases where mercury has been given 
injudiciously, or without curative effect; irresistible desire to go 
into the open air ; torturing feeling of anguish, preventing sleep. 

Aurum. — After abuse of mercury and iodide of potassium ; 
deep, tearing pains in the head ; pains pressing from above 
downward and from within outward; great mental depression, 
with suicidal tendency. 

Cinnabaris. — Most useful where there is a scrofulous state of 
the system coexisting; also when complicated with scrofulosis 
and previous mercurial izat ion combined. 

Berberis. — Tertiary form of the disease ; tearing pains in the 
whole head, slightly ameliorated by going into the open air; 
head feels swollen and bloated; disposition to weep. 

Silicea. — Cases complicated with scrofula; head feels as if it 
was teeming with living things ; pains much aggravated at night; 
swelling of the superficial glands. 

Consult, also, the following remedies: Nitric ac, Lyco- 
podium, Phytolacca, Stillingia, Kali bich., Mezereum, Corydalis, 
Arsenicum iod., Mercurius nitrosus and corrosivus, Staphisagria, 
Hecla lava, Argentum nit., Sarsaparilla. 

Auxiliary Treatment. — This consists chiefly in endeavor- 
ing to palliate the symptoms caused by cerebral hyper semia and 
cerebral tumors, which see. 



48 NERVOUS THERAPEUTICS. 

CEREBRAL TUMORS. 

Synonyms. — Tumors of the Brain ; Fr. } Tumeurs du Cerveau; 
Ger., Hirngeschwulste, Geschiviilste des Gehirns. 

Definition. — A swelling in the brain caused by some form 
of new growth. 

Diagnosis. — Cerebral tumors are sometimes of easy recog- 
nition ; at others it is impossible to diagnose them with any 
degree of certainty. Persistent headache, vomiting, double 
optic neuritis and frequent epileptic attacks are among the 
more common and prominent symptoms, and when they are 
all present in any case we are justified, in the absence of the dis- 
tinguishing signs of some other form of intracranial lesion, in 
referring the morbid phenomena to cerebral tumor. Where 
the other symptoms correspond, very limited paralysis points 
to this cause; and so, also, do epileptic convulsions occurring 
late in life, especially if unilateral, or unattended with loss of 
consciousness. 

Certain characteristic symptoms will often serve to locate 
the tumor with considerable accuracy. Thus, when seated in 
the convexity there are epileptic spasms w T ith severe headache, 
but no anaesthesia or paralysis. When the anterior lobes are 
concerned, there are frontal headache, anosmia and more or less 
mental disturbance. When one of the parietal lobes is in- 
volved there is anaesthesia, with slight unilateral paralysis. 
Tumors of the corpus striatum produce hemiplegia; of the 
corpora quadrigemina, ocular paralysis, blindness and hemi- 
plegia; of the area near the optic chiasm, headache, anosmia, 
hemiopia, paralysis of the ocular muscles, and anaesthesia of 
the parts supplied by the fifth nerve. When the cerebellum 
is implicated, the symptoms are occipital headache, vertigo 
and tottering gait. Tumors of the pons produce paralysis of 
the muscles supplied by the third, fifth and sixth nerves, 
difficulty of swallowing and crossed paralysis of the limbs. 
Tumors of the medulla oblongata produce convulsions, anaes- 
thesia, defective articulation, difficulty in swallowing, diabetes 
mellitus and paralysis of the bladder. 

Pathology. — Tumors of the brain have been classified as 



CEREBRAL TUMORS. 40 

follows: (1) The diathetic, or cancerous, tuberculous and syphi- 
litic; (2) the parasitic, or those caused by the echinococcus 
(hydatids) and those produced by the cysticercus; (3) the vas- 
cular, or aneurismal; and (4) the accidental, which include the 
6bro-plastic, gliomatous, cholesteatoraatous, osseous, enchon- 
dromatous, mucous, lipomatous, melanotic and other less 
important varieties. 

The pressure produced by cerebral tumors on the brain 
substance not only causes local symptoms, but not infrequently 
leads to fatty degeneration and atrophy of remote parts. It 
also causes displacement of the parts in the immediate vicinity 
of the tumor, renders the cerebral tissue dry and anaemic, and 
causes more or less atrophy of the nervous structure. 

Clinical Experience. — Marked relief has been obtained, in 
a number of cases, by the administration of Calc. carb., Graph., 
Sepia, Bell., Arm, Conium, Bry., Kali carb. and Bar. carb. 
Calcarea has proven most useful in atheromatous, fibrous and 
lipomatous forms; Graphites and Baryta carb. in the atheroma- 
tous and lipomatous; Sepia in the fungoid and cancerous; 
Belladonna and Kali carb. in the fibrous; Arnica in the hsema- 
tomatous; Conium in the fibroid and fibro-scirrhous. 

Therapentic Indications. — Tumors not only produce by 
pressure the symptoms of sclerosis, but they cause ansemia, 
hyper semia, hemorrhage, inflammation, softening, epilepsy, paralysis 
and atrophy. According, therefore, as the symptoms in any 
particular case correspond with one or more of these conditions, 
the remedies should be selected agreeably to the therapeutic 
indications given thereunder. 

Auxiliary Treatment. — Little can be done in these cases, 
in the way of accessory treatment, except to aid in restoring 
the contractility of the paralyzed muscles by the induced gal- 
vanic current. A moderately weak current is generally to be 
preferred, and in no case should it be strong enough to cause 
much pain. The wet sponge of one electrode should be placed 
upon the paralyzed muscle and the other held in the patient's 
hand, or applied to the nape of his neck, for a fow minutes 
every day or two. In no case should the current be allowed 
to traverse the region of the tumor. 



50 NERVOUS THERAPEUTICS. 

CEREBRAL CONCUSSION. 

Synonyms. — Concussion of the Brain, Commotio Cerebralis; 
Fr., Commotion du Cerveau; Ger., Erschiitterung des Gehirns. 

Definition. — A shock or jar given to the nervous elements 
of the brain, whereby its functions are temporarily suspended, 
and the vital power more or less depressed. 

Diagnosis. — The diagnosis is generally easily made, as 
more or less external injury, the result of a fall or blow, is 
usually associated with it. It may, however, be mistaken for 
compression, unless the symptoms are carefully compared, as 
in the following table : 

Cerebral Concussion. Cerebral Compression. 

Development sudden. Not always so. 

Can usually be roused if loudly spoken Insensibility complete. 

to. 

Respiration sighing, slow, irregular. Respiration stertorous, slow. 

Pulse soft, feeble, fluttering, intermit- Pulse slow. 

tent. 

Frequent vomiting. No vomiting. 

Urine and fseces passed involuntarily. Urine and fasces retained. 

Pupils react. Pupils insensible to light. 

Paralysis usually none; if present, gen- Paralysis usually hemiplegic. 

erallv of one or more cranial nerves. 



Pathology. — The effects produced by concussion are gener- 
ally the result of simple shock, the character of the injury 
being such as to temporarily depress the vital power, and in 
some cases to result in death. That this is always the case 
where no lesion is discoverable after death, cannot, of course, 
be proven, because a minute haemorrhage or other injury at 
some vital point, as, for example, at the internal origin of the 
pneumogastric nerve, would no doubt be sufficient to produce 
speedy death; but it is more reasonable to refer the fatal issue 
in these cases to shock alone than to causes which may have 
no existence. 

Clinical Experience. — Glonoin, Arnica and Camphora are 
usually the first remedies prescribed in these cases, Aconite 



CEREBRAL CONCUSSION. 51 

being given in alternation with them to moderate reaction 
ami to prevent inflammation. After reaction is established, if 
attended with cerebral disturbances, Belladonna, Hyoscyamus or 
Stramonium is usually given, as may be indicated. Opium 
and Lauwcerasus are sometimes used, in cases where there is 
great depression, stertor and tendency to collapse. 

Therapeutic Indications. — Glonoin. — Reactive power feeble 
and of slow development; pulse weak; surface cold but not 
clammy. 

Arnica. — An excellent remedy for injuries of the brain at- 
tended by insensibility and unconsciousness; if fever super- 
venes, alternate with Aconite. 

Camphora. — During the first stage, to promote reaction; sur- 
face cold and clammy; face pale; muscular twitchings. 

Cicuta. — First stage, insensibility profound; face cold and 
deadly pale; cold, hands, feet and limbs; inability to swallow; 
great depression of the vital power; delirium; convulsions. 

Hypericum. — Second stage, with frequent pulse, swollen face, 
short breathing and tendency to start, with shuddering over 
the whole body. 

Belladonna. — Second stage, when attended by excessive reac- 
tion; headache, flushed face and delirium; if fever is high, 
alternate with Aconite. 

Hyoscyamus. — Second stage, attended by low, furious delirium. 

Gelsemium. — Remains stupid and drowsy after slow reaction; 
pain in back of the head, pupils still dilated ; paralysis of the 
lower sphincters. 

Laurocerasus. — Slow, feeble pulse; sunken countenance; skin 
cold and blue; audible breathing, with moaning; trembling 
of the limbs; involuntary discharge of faeces. 

Vipera. — Pulse slow, feeble and irregular; surface cold and 
covered with cold perspiration; difficulty of swallowing; hemi- 
plegia, or paralysis of a single limb; vomiting; delirium. 

Lachesis. — Apoplectic symptoms, with low, muttering delirium, 
pale face, cold extremities; paralysis of the left side. 

Conium. — Apoplectic symptoms, slow, weak pulse; dilated 
pupils; tendency to collapse; trembling of the limbs; delirium, 
convulsions, numbness, paralysis. 



52 NERVOUS THERAPEUTICS. 

Auxiliary Treatment. — Brandy internally, or Amyl nit. 
by inhalation, is among the speediest means of overcoming 
the depression of the vital power, but care should be taken 
not to overstimulate the circulation, the aim being simply to 
reestablish the normal condition. In most cases it is only 
necessary to wrap the patient in warm blankets, apply friction 
to the surface, and use dry heat to the extremities. As soon as 
reaction sets in, the case is one for medical treatment only, no 
other form of stimulation being appropriate. 

SUNSTROKE. 

Synonyms. — Insolation, Insolatio, Heatstroke, Thermic 
Fever; Ft., Coup de Soleil; Ger., Sonnenstich. 

Definition. — Various syncopal, asphyxial and hyperpy- 
rexial conditions, resulting from exposure to solar or artificial 
heat. 

Diagnosis. — The appearance of the patient, taken in con- 
nection with the history of the case, is usually sufficient to 
establish the diagnosis. By comparing the symptoms with 
those given in the table on page 50, it may be easily distin- 
guished from concussion and compression, with which alone it 
is liable to be confounded. 

Pathology. — In rapidly fatal cases the brain and its mem- 
branes, and also the lungs, are but slightly congested ; the 
greatest changes are observed in the venous trunks, especially 
those of the abdomen, the right side of the heart and the pul- 
monary vessels, all of which are sometimes engorged with 
dark, grumous blood, while patches of ecchymoses are also 
scattered over the surface of the body. These appearances 
are chiefly due to nervous shock, which, by paralyzing the 
heart and lungs, leaves the venous system engorged with 
blood. In thermic cases a similar condition often exists, to- 
gether with a more or less congested state of the brain and its 
membranes. This condition is the result of heat on the nerve- 
centres, and through them on the vaso-motor nerves. As a 
consequence, the nerve-centres generally, and especially the 
respiratory, suffer from overstimulation, and this is followed 
by exhaustion. 



SUNSTROKE. 53 

Clinical Experience. — Glorioin, Arnica, Camphora, Amyl 
nit., Gelsemium, Belladonna, Veratrwn rir., Lachesis, Scutellaria, 
Cactus and Carbo veg. are the principal remedies relied upon 

in the treatment of sunstroke. 

Therapeutic Indications. — Glonoin. — After reaction has 
set in, or when there is intense headache, with throbbing in 
all parts of the head ; painful constriction of the heart; sensation 
as if all the blood had gone to the head; fainty feeling, with 
complete muscular relaxation; oppression of breathing, with 
numbness of the limbs. Especially adapted to the thermic 
and syncopal forms. 

Amyl nit. — Violent determination of blood to the head and 
face; violent beating of the cervical and temporal arteries; 
great difficulty of breathing. 

Camphora. — Great depression of both the nervous and circu- 
latory systems; coldness of the body; tremors and cramps; 
oppression of breathing; syncopal form. 

Belladonna. — Indicated when apoplectic or irritative symp- 
toms exist, such as coma, stertorous breathing, headache, 
vertigo, delirium, sensitiveness to light and sound, etc. 

Antimonium crud. — Syncopal form, with fainting, nausea, 
vomiting, etc. 

Carbo veg. — Extreme prostration of the vital power; heat 
exhaustion. 

Aconite. — Thermic form ; burning heat, especially in the 
head and face ; heat and dryness of the skin, with thirst, head- 
ache, redness of the eyes, anxiety and difficulty of breathing. 

Veratrum vir. — Congestion to the head and chest; gastric 
disturbances, especially vomiting; fainting, with coldness of 
the limbs. Useful in both the thermic and syncopal forms 
of sunstroke. 

Scutellaria. — Great fulness and oppression of the head, with 
flushed face; oppression of the chest, with throbbing about the 
heart; general uneasiness, with twitching of the muscles ; 
sticking pains in various parts of the body. 

Arnica. — Often the only remedy required, especially in the 
syncopal form ; also useful where there is great depression of 
the vital power, w r ith coldness of the limbs, stupor and semi- 
paralysis. 



54 NERVOUS THERAPEUTICS. 

Digitalis. — Cardiac weakness, with great prostration and 
tendency to syncope from heat-exhaustion. 

Auxiliary Treatment. — In ordinary cases of sunstroke, 
arising from long exposure to the direct rays of the sun, or 
where the temperature is far above the normal standard, the 
burning heat of the surface should be reduced as quickly as 
possible by the free application of the cold water douche, ice 
and ice-water to the head and neck, cool air, fanning, etc., 
being careful at the same time not to use the ice or the douche 
too long, or after the skin becomes cool. On the other hand, 
these measures should never be adopted if the skin be cold 
and clammy and the respiration sighing. The syncopal form, 
arising from heat-exhaustion, requires precisely the opposite 
treatment. In these cases there is an entire absence of fever, 
the pulse is soft and compressible and the skin cool. The 
indications here may be met by lowering the head and giving 
the patient small and frequent quantities of hot beef-tea, store 
tea, coca, etc. This condition calls for Digitalis rather than 
alcohol, the remedy usually administered. For further in- 
formation on this subject, see the author's work on Intracranial 
Diseases, p. 294. 

CEREBRAL PARALYSIS. 

Synonyms. — Paralysis of Cerebral Origin, Common Palsy, 
Hemiplegia; Fr., Paralysie Cerebrate; Ger., Gehirnldkmung. 

Definition. — Loss of the power of voluntarily exciting the 
contraction of muscles on one side of the body, caused by dis- 
ease of the brain. 

Diagnosis. — Cerebral paralysis may generally be distin- 
guished from paralysis of spinal origin by its being confined 
to one lateral half of the body. When complete, as in most 
cases of cerebral haemorrhage and other varieties of apoplexy, 
it usually takes the form of hemiplegia. Very rarely the 
paralysis, instead of being unilateral, is bilateral ; but then it 
occurs as two separate hemiplegias, not as a paraplegia, one 
side being more severely affected than the other. Not infre- 
quently the paralysis is limited to the parts supplied by par- 
ticular nerves and plexuses. Cerebral symptoms, more or less 



CEREBRAL PARALYSIS. 55 

conspicuous, are almost invariably present, such as those 
which characterize cerebral haemorrhage, thrombosis, embo- 
lism, tumors, etc., these being the principal causes of the paral- 
ysis. Motor irritation, in the forms of muscular spasm, twitch- 
ing and contraction, is common in the affected parts, and so 
also are epileptiform convulsions; but reflex movements are 
commonly preserved, and even increased in energy, while 
automatic and associated movements remain, as a rule, 
unaltered. 

Pathology. — Encephalic lesions, of various kinds, constitute 
the gross pathological condition in cerebral paralysis. These 
lesions are numerous and varied, comprising haemorrhage, 
vascular obstruction, inflammation, softening, tumors, etc. 
They give rise to certain characteristic symptoms, according 
to the particular part affected. Thus paralysis arising from 
lesions of the cortex takes the form of monoplegias, partial 
hemiplegias, paralyses of the glossal, facial and brachial 
nerves, or of the nerves of the face and arm, or arm and leg. 
Lesions implicating the region of the basal ganglia, if exten- 
sive, produce hemiplegia and cerebral hemianesthesia. When 
the region of the left middle cerebral artery is invaded we 
usually have aphasia. Cerebellar disease produces incoordi- 
nation and a titubating gait. A peculiar form of alternate 
paralysis is produced by lesions in the lower and inner part 
of the eras cerebri, and in the lower lateral half of the pons. 
In the former case, the motor-oculi nerve is paralyzed on the 
side of the lesion, and at the same time there is a hemiplegic 
condition of the opposite side of the face and body ; in the 
latter, a paralysis of the face on the side of the lesion, and 
more or less paralysis of the trunk and limbs on the opposite 
side. Lesions of the medulla oblongata, in addition to paral- 
ysis, give rise to respiratory and circulatory disturbances, 
aphonia, dysphagia, anaesthesia, dysesthesia, etc., from impli- 
cation of nerve roots arising from it. Atrophy of the muscles 
seldom occurs in connection with cerebral paralysis except in 
disease of the pons. 

The therapeutic indications pertaining to cerebral paral- 
ysis are given under the several diseases of which the paralysis 



56 



NERVOUS THERAPEUTICS. 



is a symptom, especially cerebral hemorrhage. See, also, infantile 
cerebral paralysis and progressive general paralysis. 

INFANTILE CEREBRAL PARALYSIS. 

Synonyms. — Poliencepalitis Acuta, Hemiplegia Cerebralis, 
Spastica; Fr., Paralysie Cerebrale de VEnjance; Ger., Kinder- 
Ulhmung des Gehirns. 

Definition. — A peculiar form of infantile paralysis, of en- 
cephalic origin, usually hemiplegic, and commonly attended 
by athetosis, epilepsy and impaired intellect. 

Diagnosis. — The disease is most liable to be mistaken for 
infantile spinal paralysis, from which it may be differentiated 
by means of the following table: 



Infantile Spinal Paralysis. 



Cerebral Paralysis. 



Initial stage. 


Fever, convulsions, loss of con- 




sciousness. These may all 




fail, and this stage be un- 




noticed. 


Age. 


Paralysis usually begins 1 — 4, 




seldom later. 


Paralysis. 


Monoplegias and paraplegias, 




seldom hemiplegias. 


The nature of the 


Muscles "flail-like," contract- 


paralysis. 


ures form after long time. 


Electric reac- 


Faradaism strongly reduced. 


tions. 


K. D. obtained. 


Sensation. 


Unchanged. 


Tendon reflexes. 


Lost. 



Temperature and j Lowered, and limbs look livid 
color of limbs, i and feel cold. 

Inhibition of Strongly marked, 
growth. 



Motor affections. 

Intelligence. 

Bladder and rec- 
tum. 

Paretic contract- 
ures. 



Not present. 
Unaffected. 
Not affected. 

Pes varus, 
" valgus, 
" calcaneous, 
" equinus, 



and com- 
binations of 
these. 



The same. 



Generally under 4, may occur 
immediately after birth. 

Hemiplegias commonest, mon- 
oplegias sometimes, para- 
plegia rare. 

Slight contractures form early, 
recovery is constant. 

Faradaism retained, no R. D. 

Scarcely changed. 

Exaggerated. 

Temperature not lowered, 

limbs of normal color and 

warmth. 
Not so marked, generally 

mostly so in upper limb. 
Athetosis and epilepsy. 
Often lost. 
Now and then slightly affected. 

Generally nothing except equ- 
inus spasticus, and con- 
traction of knee. 



INFANTILE CEREBRAL PARALYSIS. 5*3 

Pathology. — The motor gray matter of the cerebral cortex 
is the scat oi' an inflammatory process, pathologically resem- 
bling that found in acute spinal paralysis, leading to perma- 
nent loss of function of the part, due to subsequent atrophy 
and destruction of the affected area. 

Clinical Experience. — I can find no well-defined homoeo- 
pathic clinical experience recorded concerning this newly- 
described disease; but as it is of a similar nature to infantile 
spinal paralysis, and as cerebral cases of what have heretofore 
been regarded as cases of that disease have occasionally been 
described under the name of the "essential paralysis of child- 
hood," we are justified, I think, in regarding the clinical his- 
tory of such cases as belonging to this affection. This gives 
us Stannum, Gelsemium, Arnica and Belladonna as being reme- 
dies of marked value in this disease. 

Therapeutic Indications. — Stannum. — Paralyzed parts con- 
stantly moist from perspiration ; paralysis of the left side; pain, 
accompanied with a sense of faintness in the brain. 

Gelsemium. — Loss of will-power over the muscles ; pain in the 
top and back of the head, with stupor, verging to coma; con- 
vulsions, followed by paralysis. 

Belladonna. — Paralysis of the right side; great restlessness, 
with sudden startings; congestion and irritation of the brain. 

Arnica. — Cerebral inflammation, followed by exudation; the 
child cannot bear to have its head moved, owing to soreness of 
the brain. 

Consult, also, the indications given under acute hydrocephalus, 
progressive general paralysis and infantile spinal paralysis. 

Auxiliary Treatment. — Ice or ice-coid water applied to 
the head during the initial stage is useful, but at a later period 
cloths wrung out of hot water are more serviceable. Great care 
should be taken to keep the lower extremities, and especially 
the paralyzed parts, warm. At a later stage, moral treat- 
ment may be necessar} 7 , in consequence of the dementia, 
especially as regards cleanliness, the imitative faculty being- 
trained for this purpose. 



58 NERVOUS THERAPEUTICS. 

EXTERNAL CEREBRAL PACHYMENINGITIS. 

Synonyms. — Traumatic Cerebral Pachymeningitis, Second- 
ary Pachymeningitis, Pachymeningitis Acuta; Fr., Pachymen- 
ingite Secondaire; Ger., Secondare Pachymeningite. 

Definition. — Inflammation of the external layer of the 
dura mater, usually acute, but sometimes chronic, secondary to 
inflammation of the adjacent bone, and commonly due to 
injury of the head. 

Diagnosis. — This affection cannot be diagnosed with cer- 
tainty, but fever, severe headache and stupidity, coming on 
soon after an injury to the head, point to its existence. The 
diagnosis is confirmed if symptoms of pyaemia supervene, this 
being a very common complication in these cases. 

Pathology. — Both the pachymeningitis and the pyaemia, 
when present, are due to inflammation of the bone. The pyaemic 
infection is caused by the decomposing material from the seat 
of injury finding its way into the circulation through the veins 
of the diploe, which become inflamed in conjunction with 
the gangrenous osteitis. 

Clinical Experience. — Arnica, Hypericum, Belladonna and 
Aconite are usually prescribed in traumatic cases as soon as 
inflammatory symptoms appear, the two latter generally in 
alternation, after Arnica or Hypericum has been given. Mer- 
curius and Kali iod. are usually given when the symptoms 
seem to depend upon syphilis or when the case has a syph- 
ilitic history. Gelsemium and Opium are resorted to when 
there is much stupor. Chin, sulph. and Arsenicum are usually 
preferred after toxaemia and adynamia make their appearance, 
Calendula being sometimes previously given to prevent suppu- 
ration. Eucalyptus and Salicylic ac. are also sometimes given 
as antiseptic remedies. 

Therapeutic Indications.— These are similar to those 
given under the head of simple acute meningitis, which see. 

Auxiliary Treatment. — External pachymeningitis is, at 
the outset, a purely surgical disease, and demands surgical 
treatment. After carefully cleaning the wound, if the bone is 
depressed the trephine should be at once applied, so as to 



INTERNAL CKREBRAL PACHYMENINGITIS. 59 

prevent the supervention of meningitis, by elevating the bone, 
removing detached fragments, if any, and allowing a free 
escape of the secretions. A dressing of charpie, or of borated 
cotton, saturated with Calendula or Hypericum lotion, should 
then be applied, and this should be kept constantly moistened. 
The diet should be nutritious and easily digestible, but not 
stimulating. 

INTERNAL CEREBRAL PACHYMENINGITIS. 

Synonyms.— Cerebral Meningeal Haemorrhage, Haemor- 
rhagic Pachymeningitis, Chronic Pachymeningitis, Haematoma 
Durae Matris; Fr., Hemorrhagic des Meninges, Hemorrhagic Men- 
ingee Cerebrale, Apoplexie Meningee; Ger., Himhautblutungen. 

Definition. — A peculiar form of meningeal haemorrhage, 
the result of chronic inflammation of the dura mater, in which 
the effused blood is collected in sacs formed of false membrane. 

Diagnosis. — A constant and very severe headache, with a 
gradually increasing tendency to stupor, slow and irregular 
pulse, contracted pupils, but unattended by facial paralysis, 
convulsions, fever or vomiting, is regarded by Jaccoud and 
others as sufficient to indicate the existence of this form of 
meningeal hemorrhage. 

Pathology. — Extra and intra-meningeal haemorrhages are 
almost always the result of direct injury, such as is produced 
by wounds, trephining, etc.; but haematoma of the dura mater 
is the result of chronic pachymeningitis, and is met with under 
the dura mater, in the form of oval sacs, sometimes several 
inches in diameter, and half an inch or so in thickness. They 
are generally seated near the sagittal suture, and extend to 
both hemispheres, with only the arachnoid and pia mater 
between. The contained blood is either in a liquid or a co- 
agulated condition, and, as in other sanguineous collections, 
exhibits in different cases similar stages of degeneration. 

Clinical Experience. — This does not materially differ from 
what is given under this head in cerebral hyper semia, haemor- 
rhage and tumors, which see. 

Therapeutic Indications. — Identical with those given in 



60 NERVOUS THERAPEUTICS. 

treating of the above-named diseases, and to which reference 
should be made. 

Auxiliary Treatment. — The great mental and bodily in- 
firmity which sooner or later overtakes the patient may be 
palliated, and its development retarded, by such hygienic 
measures as are calculated to invigorate the system, such as 
fresh air, good, nutritious food, agreeable company, etc. 

CEREBRAL ARACHNITIS. 

Synonyms. — Inflammation of the Arachnoid Membrane of 
the Brain, Traumatic Arachnitis; Fr., Inflammation de VArach- 
noide; Ger., Entzundung der Arachnoidea. 

Definition. — Inflammation of the cerebral arachnoid mem- 
brane, due in most cases to injury of the head. 

Diagnosis. — If the evidences of arachnitis are widely dif- 
fused over one of the hemispheres, and are at the same time 
accompanied by hemiplegia of the opposite limbs, the hemi- 
plegia involving both sensation and motion, we may safely 
conclude that the case is one of true cerebral arachnitis. 

Pathology. — The possibility of the existence of cerebral 
arachnitis has been called in question on the grounds that the 
so-called parietal layer of the arachnoid does not exist, while 
the inflammation of the visceral layer never occurs without 
simultaneous inflammation of the pia mater; but this opinion 
is successfully controverted by the fact that in cerebral arach- 
nitis an even layer of purulent lymph is found to cover the 
cerebral convolutions without dipping into the sulci, being 
prevented by the intervening arachnoid membrane, which 
stretches across instead of entering the cerebral depressions; 
whereas, when the subarachnoid spaces are involved, the sulci 
are filled with lymph, and the internal surface of the arach- 
noid remains free and unaffected. 

Clinical Experience. — This is the same as in inflammation 
of the adjacent membranes — Aconite, Belladonna, Apis, Bryonia, 
Mercurius, Kali iod. and Sulphur being given according to the 
special indications. 

Therapeutic Indications. — These do not materially differ 



TRAUMATIC CEREBRAL LEPTOMENINGITIS. 61 

from those giveD under the head of simple cerebral meningitis, 
which see. 

Auxiliary Treatment. — Traumatic cases require surgical 
treatment, similar to that given under the head of external cere- 
bral pachymeningitis, to which reference should be made. Idio- 
pathic cases, which are comparatively rare, are usually com- 
plicated with simple cerebral meningitis, and therefore the 
accessory treatment recommended thereunder will be appro- 
priate. 

TRAUMATIC CEREBRAL LEPTOMENINGITIS. 

Synonyms. — Traumatic Inflammation of the Pia Mater of 
the Brain, Subarachnoid Meningitis, Leptomeningitis Cere- 
bralis; Ft., Meningite Consecutifs a la Carie du Rocker; Ger., 
Secondare Leptomeningite, Akute Connexitdts Meningitis. 

Definition. — An inflammation of the pia mater of the brain, 
involving primarily the areolar tissue of the subarachnoidean 
spaces, usually due to some injury implicating the base of the 
skull. 

Diagnosis. — The disease may be suspected when, after sup- 
posed injury of the base of the skull, vague cerebral symptoms, 
unattended by decided paralysis, make their appearance; and 
if the petrous bone has been fractured, as shown by bleeding 
from the ear and deafness, with facial paralysis in the first 
place, then the existence of this form of meningitis may be 
regarded as reasonably certain. 

Pathology. — The inflammation is supposed to gain access to 
the subarachnoid spaces by traveling along the trunk of the 
seventh nerve, and afterward spreading upward through the 
posterior fissures to the ventricles, or over the surface of the 
hemispheres, or else downward on the medulla oblongata and 
its connections. The subarachnoidean inflammation may, 
however, result from the admission of air through the fracture, 
either by way of the external meatus or the Eustachian tube, 
for the fracture, instead of being a simple one, is actually com- 
pound. Indeed, it is highly probable that this is the true 
explanation, as the admission of air into wounds, especially 



62 NERVOUS THERAPEUTICS. 

suppurating ones, not only greatly changes the character of 
the inflammation, but contaminates the air itself, which may 
thereafter become the vehicle of its transfer to more distant 
parts. 

Clinical Experience. — Apis, Hypericum, Bryonia and Silicea 
have been given with good results in this form of leptomenin- 
gitis, though such cases, in the long run, almost always prove 
fatal. Apis and Bryonia are given to promote absorption of 
serous effusions, and Silicea to limit or prevent suppurative 
action. 

Therapeutic Indications. — These are similar to those 
given under the head of simple cerebral meningitis, which see. 

Auxiliary Treatment. — There is nothing very peculiar 
about this form of meningeal inflammation, except so far as its 
surgical features are concerned. Should the discharge from 
the ear become purulent — which, if the patient lives, it is 
almost certain to do — great care should be taken to insure its 
free and uninterrupted evacuation, and for this purpose I have 
usually found nothing better than warm fomentations, or the 
steam from a steam atomizer, applied to the aural region, 
whenever the flow becomes suddenly interrupted or the patient 
suddenly comatose. 

SIMPLE ACUTE CEREBRAL MENINGITIS. 

Synonyms. — Meningitis, Cerebral Meningitis, Simple Cere- 
bral Meningitis, Idiopathic Cerebral Leptomeningitis, Lepto- 
meningitis Cerebralis, Leptomeningitis Infantum, Hydro- 
cephalus Acutus sine Tuberculosis; Fr., Meningite Simple ; Ger., 
Allgemeine Akute Hirnhautentzundiing. 

Definition. — A simple acute inflammation of the pia mater 
of the brain. 

Diagnosis. — Simple cerebral meningitis is most liable to be 
mistaken for the tubercular form of the disease, especially 
when it involves the base of the brain. The following table 
gives the differential diagnosis between them : 



SIMPLE AcUTK CEREBRAL MENINGITIS. 



63 



Tubercular Meningitis. 



Simple Basilar Meningitis. 



Onset gradual. 

Temperature 102° to 103°, not continu- 
ous but very irregular, falling some- 
times for a day or so down to 
normal, or nearly so. 

Pulse compressible, rapid, and, after 
first week, intermitting, losing occa- 
sionally a beat. 

Face looks usually pale. 

Eyes not injected; squinting toward 
end of disease ; pupils uncertain, 
later dilated. 

Tongue slightly coated. 

Vomiting frequently in the beginning ; 
will appear by itself, not only after 
eating ; ceases generally when con- 
vulsions begin, toward latter part 
of disease. 

Bowels very constipated. 

Cough harassing and obstinate; gen- 
erally physical signs of tubercular 
deposits in the apices. 

Convulsions appear at beginning of 
about last third of the ailment; may 
continue for one or more weeks, 
gradually increasing in number 
and severity as death approaches. 

Duration about three weeks; may be 
much longer. 

Prognosis : invariably fatal. 

Post-mortem appearances: deposits of 
small tubercular bodies, mainly at 
the base of the brain ; signs of in- 
flammation of membranes, effusion 
of fluid and formation of lymph; 
deposits in other parts of the body. 



Beginning most abrupt. 

Temperature 102° to 103£°; continues 
at that height throughout the dis- 
ease; never sudden and great 
changes. 

Pulse rapid and somewhat tense ; always 
regular, except, perhaps, during 
agony of death. 

Face flushed. 

Eyes always injected, occasionally 
squinting ; eyes apt to be very sensi- 
tive to light; pupils often con- 
tracted. 

Tongue red. 

Vomiting generally first symptom, and 
continues to the last ; happens only 
immediately after eating. 



Bowels not constipated ; there is often 

diarrhoea. 
Cough mild; mostly due to bronchial 

irritation ; percussion clear. 

Convulsions immediately before death, 
never continuing longer than a 
day, or at most two, followed by 
a comatose condition. 

Duration less than a week ; sometimes 
only two to four days; never longer 
than seven. 

Prognosis: grave, but not necessarily 
fatal. 

Post-mortem appearances: never any 
granular deposits; signs of inflam- 
mation of arachnoid and pia mater, 
often severe, especially at the base; 
associated with abundant effusion 
and copious accumulation of 
lymph. 



Pathology. — It is generally supposed that no gross patho- 



64 NERVOUS THERAPEUTICS. 

logical changes involving the pia mater are discoverable 
after death by this disease; but this is not, strictly speak- 
ing, correct. Abnormalties are found, according to the stage 
of the disease, consisting either of a gelatinous white or yellow 
lymph-like matter, puriform, or else in the form of membranous 
layers. They are generally limited to the convexity, but some- 
times they involve both the lateral regions and the base of the 
brain. The inflammation is not always confined to the pia 
mater, but sometimes implicates the adjacent tissues, in which 
case we have a meningo-cerebritis, of variable seat and extent. 

Clinical Experience. — The remedies most commonly em- 
ployed in simple meningitis are : Aconite during the initial 
stage, with high fever, delirium, etc., followed by Belladonna, 
Atrophine Sx, Hyoscyamu&, Stramonium or Bryonia, as the 
delirium, pains, etc., become more pronounced and severe. Apis, 
Helleborus, Bryonia, and sometimes Opium are given when 
there are much depression and stupor, indicating effusion, or 
when there are low muttering delirium, coldness of the ex- 
tremities, etc. Zincum and Zincum brom. have proved beneficial 
in advanced cases, even after paralysis has supervened. 

Therapeutic Indications. — Aconite. — At the outset of the 
disease, or when there is high fever, with dry, burning heat of 
the skin, red inflamed eyes, pulse full and hard, pupils con- 
tracted and burning, throbbing or lancinating pains in and 
through the whole head; anxiety or great anguish; delirium; 
vomiting of bile; convulsions; spasmodic contractions; pa- 
ralysis. 

Belladonna. — Face and skin red, burning and swollen; red 
and sparkling eyes; lancinating, stinging or burning headache; 
delirium, with frequent vomiting; pulse small and quick, or 
intermittent; insensibility, spasms and paralysis. 

Hyoscyamus. — Delirium, gradually passing into stupor and 
coma; red, burning face, red and sparkling eyes, con- 
tracted pupils, strong and quick pulse, sticking pains in the 
head; wild delirium, the patient singing, muttering, smiling, 
talking wildly ; starting suddenly; picking at the bed-clothes, 
with loss of consciousness, dilated pupils, cold and pale face, 
weak and intermitting pulse and paralysis. 



SIMPLE ACUTE CEREBRAL MENINGITIS. 65 

Digitalis. — Stupor, gradually deepening into coma ; irregu- 
lar action of the heart, sometimes very weak, at others strong; 
small and slow pulse; dilated pupils, with insensibility of 
vision ; general or partial convulsions ; especially suited to the 
last stage, or stage of depression. 

Apis mel. — Infantile cases, with delirium, loss of conscious- 
ness and occasional shrill screams; bending back and rolling of 
the head ; squinting of the eyes ; child puts its hand to its 
head while it screams, even when unconscious ; face pale, or 
marked with red streaks or spots; scanty or suppressed urine; 
very frequent and weak pulse, or else slow and irregular ; con- 
vulsions, trembling of the limbs and paralysis. Secondary 
meningitis from suppressed erysipelas or other exanthem. 

Stramonium. — Violent delirium, accompanied by frightful 
screams; opisthotonos; vomiting; red face, with thirst and 
great dryness of the mouth ; convulsive movements of the 
limbs ; moaning and tossing about ; staring look, especially on 
waking; feverish heat, moist skin; sleep almost natural, but on 
being aroused patient does not recognize his friends; retention 
of urine. 

Cuprum. — Head hot, with sharp, lancinating pains shooting 
through it ; red, inflamed and rolling eyes, with delirium or 
stupor; quick, strong pulse, with more or less vomiting; tonic 
spasms and convulsions; suited also to the last stage, attended 
with slow, small and weak pulse, blue, shrunken face, dimness 
of vision, moist hands and paralysis ; specially adapted to cases 
in which there is irritation of the spinal cord. 

Bryonia. — During the first stage, with sharp, shooting pains 
in the head, especially through the temples, red and inflamed 
eyes, hot and burning skin, delirium, cramps, etc. ; also, at a 
later period, when the disease is verging into that of depression, with 
stupor, dim and glossy eyes, slow and irregular pulse, cold, 
pale, moist skin, dry and brownish tongue; also when the 
patient bends the head backward, constantly w T orks the jaws, 
or starts suddenly from sleep, screaming, with cold sweat on 
the forehead. 

Glonoin. — Intense headache, with throbbing of the temporal 
arteries, red face, full and rapid pulse, hot and staring eyes, 



66 NERVOUS THERAPEUTICS. 

ringing in the ears and vomiting ; brain feels too large for the 
skull ; globe of the eye feels sore ; irregular pulse, with moist skin. 
Suited to every stage of the complaint. 

Gelsemium. — Child drowsy and wants to be let alone ; fre- 
quent startings in sleep ; bores its head backward into the pillow; 
constant fever, though without much thirst; head hot, but the 
hands and feet cool and moist; nausea, with blindness; espe- 
cially suited to children teething. 

Cimicifuga. — Pain in and behind the eyeballs, extending 
through to the occiput ; tongue clean, but pointed and trem- 
bling ; pain increased by movement of the eyes ; soreness and 
stiffness of the muscles ; excruciating pains in the head, increased 
by movement; delirium, with incessant talking. 

Helleborus. — Head drawn back, with stiffness of the cervical 
muscles ; eyes staring and oblique ; forehead contracted and cov- 
ered with perspiration ; frequent starting and screaming during 
sleep; working of the jaws; breathing irregular, sometimes 
quick, at others slow and deep, or sighing; jerking of the limbs, 
with convulsive movements of individual muscles. 

Opium. — Stupor and insensibility, with stertorous breathing, 
dilated pupils, half-open eyes, small, weak, irregular pulse and 
suppressed urine ; when aroused, patient relapses immediately 
into a state of insensibility. 

iEthusa cyn. — Obstinate vomiting; pupils dilated and in- 
sensible to light ; coma, with cold skin, pale face and collapsed 
appearance ; drawing in the back of the neck ; tetanic convul- 
sions. 

Anacardium. — S.equlse of brain fever, with total loss of mem- 
ory ; weakness of all the special senses ; mental dulness and 
confusion ; incomplete paralysis of the voluntary muscles. 

Auxiliary Treatment. — During the active, inflammatory 
stage, marked by high fever and excitement, ice to the head is 
almost indispensable ; at a later period, and especially during 
the stage of depression, cloths wrung out of hot water are more 
suitable. As the power to digest proteids is nearly, if not 
quite, abolished, and the secretion of saliva greatly diminished, 
only such articles as sweet whey, fruit decoctions, water gruel, 
etc., will be appropriate until the beginning of convalescence, 



TUBERCULAR CEREBRAL MENINGITIS. 67 

when we may gradually administer more concentrated farina- 
cious preparations, milk, with malt extract, light broth or 
Liebig's infant food. This cautious diet is necessary during 
the stage of convalescence, because, if complicated with fever, 
as it is apt to be from indigestion, the disturbance thus pro- 
duced is liable to retard the absorption of the exudation. 

TUBERCULAR CEREBRAL MENINGITIS. 

Synonyms. — Tubercular Inflammation of the Cerebral 
Meninges, Granular Meningitis, Acute Hydrocephalus, Hy- 
drocephalus Internus, Tubercular Leptomeningitis ; Fr., Fievre 
Cerebrate, Meningite Tuberculeuse, Meningite Granuleuse ; Ger., 
Tuberculose Hirnhautentzundung . 

Definition. — An acute inflammation of the cerebral mem- 
branes, especially of the pia mater, at the base of the brain, 
complicated with, and dependent upon, a growth of tubercles 
in the brain and other parts of the body. 

Diagnosis. — The differential diagnosis between this disease 
and simple basilar meningitis is given under the latter head, 
which see. Typhoid fever, to which at times it bears a very 
close resemblance, may be distinguished from it by means of 
the following table: 



Tubercular Meningitis. Typhoid Fever. 



First Stage. 

There is a gradual loss of flesh, extend- ' Loss of flesh only apparent after fever- 
ing over some weeks or months. process has existed some time. 

Irritability more intense and prolonged; i Irritability not so intense; quieter dur- 

restless during sleep. ing sleep. 

Shunning light is common. j Absent. 

Temperature has no characteristic ; Typical fever curve; gradual ascent, 

change ; may be high in the morn- j having low fever in the morning 

ing and low in the evening, or the ! and higher in the evening. 
same morning and evening. 

Vomiting causeless, and not connected Vomiting nearly always connected with 

with ingesta. May find a clean curdled milk or repugnant medi- 

tongue. cine. Coated tongue. 



68 



NERVOUS THERAPEUTICS. 



Second Stage. 



Headache not aggravated at any partic- 
ular time of the day. 
Nearly always constipation. 

No abdominal tenderness. 

Pulse of good volume, moderately slow, 

and occasionally irregular. 
No epistaxis. 



Headache always aggravated toward 
evening, when the fever ascends. 

Diarrhoea, as a rule; exceptionally, 
constipation. 

Abdominal tenderness and tympanitis. 

Pulse soft, rapid, and never irregular. 

Often epistaxis. 



Third or Advanced Stage. 



Irregular temperature curve or no fever 
at all. 

Now the vomiting generally ceases. 

Stupor is continual, patient not easily 
aroused, and immediately falls 
back again into his former state. 

Obstinate constipation. 

Extraction of abdomen. 

Tache cerebral e ; sudden and spontane- 
ous blushing of cheek and of parts 
exposed to pressure. 

Cheyne-Stokes breathing. 



Pulse very irregular. 

Spleen normal. 

Local palsies and local spasms ; fixed- 
ness of the eyes; unequal or di- 
lated pupil. 

Extreme tenderness elicited on press- 
ing the femur. 

Urohaematin, but no albumen or indi- 
can in the urine. 



Continued fever, stationary, or ascend- 
ing gradually with the morning re- 
mission. 

May have vomiting of ingesta. 

Is easily aroused ; remains awake for a 
time and requests drink. Is usually 
rational during the time of being 
awake. 

Generally diarrhoea, yellow or brown- 
ish stools. 

Tympanitis and tender abdomen. 

Eoseolar eruption. 



Breathing at times very irregular, quite 
sighing, but not the rhythmical ir- 
regularity. One day regular, and 
the next very irregular. 

Pulse weak and regular. 

Spleen enlarged and tender. 

No such manifestations. 



No tenderness on pressure. 

Indican and albumen always present in 
the urine. 



Pathology. — The tubercular matter is mainly found along 
the course of the vessels of the pia mater, at the base of the 
brain, a fact which serves to explain the motor disturbances 
observed in this disease. Its ordinary seat is along the middle 
meningeal artery and its branches ; but it is sometimes depos- 
ited, though rarely, on the convexity. The pia mater is always 



TUBERCULAR CEREBRAL MENINGITIS. 69 

more or loss inflamed, thickened, infiltrated, and covered with 
Bero-plastic or purulent exudates. The ventricles are distended 
with serum, sometimes to the point of rupture. The tuber- 
cular matter is not confined to the brain, but is usually met 
with in other organs, especially the lungs. 

Clinical Experience. — Dr. Price, of Baltimore, thinks that 
he has cured at least four cases of this disease by means of 
HeUeborus, Bryonia, Apis and Artemisia vulg. Other remedies 
which have been given with greater or less benefit in tuber- 
cular meningitis are: Cicuta, Veratrum alb., Argentum nit., Kali 
iod., Calcarea phos., Zincum, Belladonna, Spongia, Gelsemium 
and Cina. 

Therapeutic Indications.— Artemisia vulg.— Child lies in 
a sleepy or dreamy state, drinking freely of water without 
being aroused ; surface cold, left side paralyzed, right in a state 
of chronic convulsion; involuntary stools. Especialty indicated 
in the last stage. 

HeUeborus. — Soporose condition; forehead wrinkled and 
covered with cold perspiration; dilated pupils; involuntary 
throwing about of one arm or leg; lower jaw hangs down; 
paralysis of one side. Chiefly indicated in the last stage of the 
disease, or after paralysis has set in. 

Bryonia. — Constant working of the jaws; lips dry and 
parched; the least motion produces fainting or nausea ; constipa- 
tion ; symptoms changing to those of depression. Indicated after 
effusion has set in, and the system has become more or less 
depressed. 

Apis. — Stupor ; constant motion of one arm or leg ; urine 
scanty or suppressed; involuntar}^ stools, which are green ? 
lumpy and slimy; pulse irregular; one side paralyzed, the 
other convulsed. Specially indicated after exudation has taken 
place. 

Calcarea carb. — Lively, precocious, large-headed children, 
with tender constitutions, a swollen abdomen and irregular 
bowels, inclined to looseness; profuse perspiration during 
sleep; child screams out unexpectedly without cause. Espe- 
cially indicated during the prodromic or irritative stage. 

Calcarea phos. — Scrofulous children, greatly emaciated, den- 



70 NERVOUS THERAPEUTICS. 

tition retarded; stools loose and green, occasionally slimy; 
child feverish and always wanting to nurse; craves potatoes 
and other forms of starchy food; slow in learning to walk; face 
pale, or yellowish and sallow; looks stupid, and takes no 
interest in anything ; fontanelles open. Scrofulous constitu- 
tions, both before and after tubercular disease has set in. 

Kali iod. — Darting pains in the head, preventing sleep ; pain 
and heat in the head, with red and burning face ; epistaxis ; 
drowsiness ; dry and hacking cough ; spasmodic muscular 
contraction ; chilliness alternating with flashes of heat ; hemi- 
plegia. Kafka advises the early use of this remedy before 
exudation has taken place as well as afterward, the remedy having 
acted favorably at both periods. 

Cina. — Irritative fever, with daily exacerbations, remitting 
after midnight; pallor about the nose and mouth; child bores 
into and picks its nose ; constantly whining and moaning ; 
cannot bear to be touched ; frequently dizzy, and occasionally 
loses consciousness. Prodromal symptoms. 

Belladonna. — Child lies in a drowsy or semicomatose state, 
from which it starts suddenly at times, but is never fully 
aroused ; is dizzy when suddenly raised up, and not infre- 
quently vomits ; opisthotonos; pupils dilated ; cannot see any- 
thing that is transpiring in the room ; pupils dilated. 

Lycopodium. — Somnolency, gradually deepening into coma ; 
convulsions, either partial or general ; child sleeps with half- 
open eyes ; is very restless, throwing its head from side to 
side; moans and screams out in sleep; face pale and cold; 
neck stiff; body greatly emaciated ; bowels costive. This is a 
highly important remedy in tubercular affections, especially 
when the head is involved. 

Spongia. — Redness of face, with anxious expression of coun- 
tenance ; hyperemia of the brain ; bending of the head back- 
ward ; face alternately red and pale ; eyes staring, lids wide 
open ; double vision ; child frequently wakes with a start ; 
muscular twitchings accompany the fever; somnolency and 
stupor. This remedy is highly recommended by Hering for 
this disease. 

Veratrum alb. — Great inequality in the distribution of heat ; 



CHRONIC CEREBRAL MENINGITIS. 71 

the least motion causes nausea or vomiting; neck stiff, with 
great tendency to convulsions; face pale, or one cheek pale 
and the other red ; great prostration after stool ; symptoms 
aggravated by raising the patient up ; extreme thirst. 

Silicea. — Children with enlarged heads and slowly-closing 
fontanelles ; heat and redness of the face, with cold extremi- 
ties ; sweat about the head, face and neck ; great drowsiness, 
but frequent startings during sleep ; stomach easily sours ; 
sour eructations, accompanied with nausea or vomiting. 

Auxiliary Treatment. — Children predisposed to this dis- 
ease, by reason of having inherited a scrofulous or tubercular 
constitution, should be carefully guarded against those unhy- 
gienic influences which favor malnutrition, such as depriva- 
tion of fresh air, sunlight, wmolesome food, and especially 
guarding against a diet that tends to induce functional de- 
rangement of the digestive organs. Even after the disease 
has set in, it is important to avoid all food that might increase 
the vomiting, and hence milk is to be omitted, giving Liebig's 
or some similar infantile food instead. 

Where the coughing is so severe as to produce congestion of 
the brain, Dr. Price, whose success in the treatment of this 
disease is exceptional, advises the inhalation of the fumes 
of Cresoline, which he says mitigates the cough more than 
Drosera, or any other remedy. 

CHRONIC CEREBRAL MENINGITIS. 

Synonyms. — Chronic Meningitis, Chronic Basilar Menin- 
gitis, and Verticular vel Convexital Meningitis, Chronic Syphi- 
litic Meningitis; Fr., Meniiigite Cerebrate Chronique; Ger., 
Chronische Hirnhauteiitzundung. 

Diagnosis. — There being no broad distinction between these 
several varieties of chronic meningitis, except that which is 
based on the location or aetiology of the morbid process, I shall 
include them all under one head. 

The comparative mildness of the symptoms, no less than 
the chronicity of their course, will serve to distinguish the 
chronic from the acute forms ; and when originating in the 



72 NERVOUS THERAPEUTICS. 

latter, the previous history of the case will be sufficient to 
establish their nature. The softening resulting from cerebral 
thrombosis may be known both by the intensity of the symp- 
toms and by the nature of the cause producing it. Thus, 
while the pain is less in softening than it is in inflammation 
of the membranes, the mental symptoms are more severe, and 
vice versa. Chronic basilar meningitis may be distinguished 
from the convexital variety by the disturbances produced by 
implication of the cranial nerves, as one or another of them 
becomes involved in the inflammatory process. 

Pathology. — The thickening and opacity observed in most 
cases of chronic cerebral meningitis are believed to arise, in 
most cases, from overstimulation, either syphilitic, alcoholic 
or mental. This is highly probable, since we know that these 
various forms of irritation are among the most common causes 
of chronic meningitis. By some, the changes above referred 
to are regarded as a mere result of degenerative overgrowth, 
brought about partly by conditions incident to advancing age, 
and partty by frequent or long-continued congestions. Syphi- 
litic deposits (gumma) are sometimes found upon the surface 
of the brain, but they are much more frequently met with at 
the base, a fact doubtless due to the much greater vascularity 
of that region. 

Clinical Experience. — Kali iod. and Mercurius well sustain 
their reputation as anti-syphilitic remedies in chronic meningeal 
affections of the brain. Experience shows, also, that the various 
remedies used in other forms of meningitis are equally bene- 
ficial in this whenever the causes can be effectively removed 
or suspended. Thus all undue mental strain, excessive 
alcoholic stimulation, venery, etc., must be abandoned before 
the irritation and inflammatory action will yield to any form 
of medication. 

Therapeutic Indications. — These are similar to those 
given under the heads of simple and tubercular meningitis, en- 
cephalitis and cerebral hyperemia, which see. The following are 
special indications in paralysis of the muscles of the eye 
and face : 

Causticum. — Paralysis of the facial and of any or all of the 
ocular muscles, especially when resulting from cold. 



CHRONIC HYDROCEPHALUS. 16 

Gelsemium. — Paralysis of the oculo-motor nerve, or when it 
gives rise to double vision; also for paralysis of the facial 
muscles, and of the tongue and organs of speech. 

Stramonium. — Paralysis of the ocular muscles when dependent 
on brain troubles, or when associated with facial paralysis. 

Kali iod. and Mercurius. — When the paralysis is of syphilitic 
origin. 

Nux vom. — When aggravated by the use of stimulants or 
tobacco. 

Spigelia. — When the paralysis is associated with sharp, stab- 
bing pains through the head. 

Opium. — Paralysis of the ciliary and facial muscles. 

Auxiliary Treatment. — The best moral and supporting 
measures, in addition to medical treatment, are generally 
required. 

CHRONIC HYDROCEPHALUS. 

Synonyms. — Dropsy of the Brain, Water on the Brain, 
Hydrops Capitis ; Fr., Hydrocephaly, Hydropsie du Cerveau; Ger., 
Der Wasserkopf, Himwasser-sucht. 

Definition. — A gradual effusion of serous fluid into the 
ventricles of the brain, in such quantity as to distend them 
and enlarge the head. 

Pathology. — As the ventricles become more and more dis- 
tended by the gradually accumulating fluid, the hemispheres 
slowly expand, the convolutions unfold, and the whole cerebral 
mass becomes thinned and. distended, until at last it resembles 
a mere bag of brain-matter filled by the expanded ventricular 
membranes and their fluid contents. At the same time both 
the membranes and the brain substance, instead of becoming 
softer and less compact, are rendered tougher and denser, the 
lining membrane of the ventricles thicker and more resisting, 
the brain-matter harder and tougher. This cannot always, nor 
even generally, be due to previous inflammatory action ; for 
while there is little, if any, atrophy of the brain substance, there 
is apparently an overgrowth of the neuroglia, due, probably, 
to the long-continued mechanical congestion of the tissues. 

Clinical Experience. — Calcarea carb., JEthusa and Sulphur 
6 



74 NERVOUS THERAPEUTICS. 

are said to give the best results in chronic hydrocephalus, al- 
though Arsenicum is, perhaps, more frequently given than any 
other remedy. Helleborus, Apis and Digitalis are also frequently 
prescribed, especially when the urine is scanty and the circu- 
lation feeble and embarrassed. Arsenicum iod., Kali iod. and 
Calcarea phos. are given in cases manifesting scrofulous and 
tubercular cachexia, tardy dentition, etc. 

Therapeutic Indications. — Calcarea carb. — Head greatly 
enlarged ; anterior fontanelle open ; old, pale, haggard expression 
of the face, which is thin and wrinkled, or swollen and puffed ; 
copious sweat on the head, neck and shoulders, especially 
when sleeping; scrofulous swelling of the superficial glands. 

JEthusa cyn. — Child cannot hold up its head, which is greatly 
enlarged ; lies in a stupor ; pulse feeble ; pupils dilated and 
insensible to light; vomits soon after nursing; scrofulous 
swelling of the cervical and axillary glands. 

Sulphur. — Most valuable as an intercurrent remedy; great 
torpor of the system ; dulness of the senses ; face pale and ema- 
ciated ; retention of urine ; constipation. 

Helleborus. — Forehead wrinkled and bathed in cold perspira- 
tion ; urine. suppressed or scanty and dark; somnolency, with 
dulness of the senses ; pupils dilated ; limbs tremble from 
weakness ; gait tottering ; passive congestion, with serous 
effusion. 

Arsenicum. — The child strikes or clutches at its head, as 
though for relief; retention or involuntary discharge of urine ; 
breathing anxious and oppressed ; special senses dull ; stomach 
emaciation and muscular weakness ; swelling of the head and face ; 
irritable and weak. 

Digitalis. — Head enlarged by copious serous exudation ; weak, 
irregular action of the heart; great prostration; coldness of the 
body and limbs ; weak feeling at the pit of the stomach ; 
tendency to faint. 

Apis mel. — Urine scanty or suppressed; pulse irregular ; trem- 
bling of the limbs, with tottering gait ; copious sweat of the head; 
stools small ; great emaciation and prostration ; dry, hot skin, 
but no thirst ; pulse very weak, while the heart beats with great 
violence. 






CHRONIC HYDROCEPHALUS. 75 

Calcarea phos. — Child takes no interest in anything ; is un- 
able to hold up its head, which is large and heavy ; posterior 
font aneUc wide open; ears and nose cold; face pale or sallow ; 
great desire for potatoes and other forms of starchy food. 

Kali iod. — Stupor, with irregular and labored breathing; 
superficial glands enlarged; urine suppressed; pupils dilated; 
scrofulous constitution. 

Apocynum can. — Forehead projecting, sutures open, head en- 
larged; stupor, with dulness of the senses, especially that of 
sight : urine scanty or suppressed ; serous exudation. 

Plumbum. — Heaviness of the head from dropsical enlarge- 
ment; pulse small and frequent, or slow and feeble; emaciation, 
with trembling of the limbs ; somnolence, with mental dul- 
ness; retention or involuntary emission of urine ; obstinate consti- 
pation : constantly growing weaker and more debilitated: 

Zincum. — Small, weak pulse; great prostration; coldness of 
the body; breathing oppressed ; limbs tremble and feel heavy • 
dulness of the special senses; head enlarged, with great out- 
ward pressure ; restlessness, especially at night ; vertigo, espe- 
cially when raised up, with nausea ; constipation. 

Auxiliary Treatment. — Hygiene is of great importance in 
the management of these cases. The head should be sup- 
ported on pillows, or by some suitable mechanical contrivance, 
in a comfortable position, and the child exposed daily to fresh 
air and sunshine. A liberal supply of good, nutritious, easily 
digestible food should be given to it with regularity. In 
short, everything possible should be done to strengthen and 
build up the system. 

As for local treatment, it has usually done more harm than 
good. Tapping appears to have relieved a few cases; but the 
ordinary result of the measure has been to hasten the fatal 
termination. Treatment by compression is as cruel as it is 
senseless, and is now happily abandoned. 



PART II. 

DISEASES OF THE SPINAL MARROW AND ITS 
MEMBRANES. 



SPINAL HYPEREMIA. 



Synonyms. — Spinal Congestion, Congestion of the Spinal 
Cord; Ft., Hyper •emie de la Moelle Epiniere ; Ger., Ruckenmarks- 
hyperdmie ; Spinalhyperamie. 

Definition. — A general or local excess of blood in the 
spinal cord and its membranes. 

Diagnosis.: — Spinal hyperemia is liable to be mistaken for 
spinal anaemia, myelitis and spinal meningitis. Hyperaemia 
of the cord is characterized by more or less anaesthesia or 
numbness, spinal anaemia by its opposite, hyperaesthesia, 
which is often excessive. The former is always aggravated 
by the recumbent position, while the latter is ameliorated by 
it. Myelitis may be distinguished from spinal hyperaemia by 
the greater intensity of the symptoms, and spinal meningitis 
by the severity of the symptoms, by the pains produced by 
movement of the paralyzed limbs, and by the tonic contrac- 
tion of the muscles, especially those of the back. 

Pathology. — The anaesthesia is supposed to be due to 
pressure upon the white substance of the cord, which is always 
greatest when the back is in a dependent position ; the same 
is true of the paralysis; while the hyperaesthesia and mus- 
cular twitchings are caused, rather, by hyperaemia, and con- 
sequent overexcitation, of the gra}^ substance. 

Clinical Experience. — The remedies most frequently pre- 
scribed for this condition of the cord are : Rhus tox., Lachesis, 
Silicea, Secale and Lathyrus sat. Next in frequency are : Aconite, 
Gelsemium, Nux vom., Argentum nit.. Oxalic ac, Colcliicum, 
Belladonna, Agaricus and Rhododendron. 



SPINAL HYPEREMIA. 77 

Therapeutic Indications. — Rhus tox. — Aching in the spine, 
with tingling, numbness and paralytic weakness in the lower 
limbs, especially when caused by exposure to cold, straining, 
etc : aggravated by rest or by lying down. 

Lachesis. — Prickling sensation in the limbs ; sinking sensation 
in the back; stinging pains in the limbs, with numbness and 
trembling weakness. 

Silicea. — Limbs " go to sleep " easily, are sore, lame and 
cold ; legs tremble and are very weak ; numbness and prick- 
ling in both upper and lower extremities ; pain and laming 
soreness in the back, increased in the recumbent position. 

Secale cor. — Weakness and numbness in the lower extremi- 
ties ; prickling sensations in the legs and feet; paralysis of 
the bladder and rectum ; produces such intense congestion of the 
cord as to destroy its functions. 

Colchicum. — Spinal hyperemia caused by suppressed per- 
spiration, or by getting the feet wet; numbness of the limbs, 
with prickling pains ; twitching pains in the limbs and side, 
w r ith sensation of lameness. 

Belladonna. — Spinal hypersemia attended by severe pains in 
the back, which are increased by lying down. 

Agaricns. — Laming numbness and formication in the lower 
limbs; tingling, prickling sensation in all the limbs; violent 
pains in the back, worse when standing. 

Aconite. — Paralysis from congestion of the cord ; crampy, 
contractive pain in hand and arm ; painful bruised sensation 
in the spine, attended by stiffness and lameness of the back ; 
trembling weakness in the lower limbs. 

Rhododendron. — Paralytic weakness during rest ; heavy, w T eak 
feeling and formication in back and limbs, worse when at rest, 
especially when lying down. 

Argentum nit. — The pain in the back is relieved by standing; 
trembling in the lower limbs, as after a fatiguing walk ; nightly 
pains in the back. 

Berberis vulg. — Xumb, bruised feeling in the back, w r orse 
when lying ; paralytic feeling in the limbs, with sensation of 
tingling and prickling in them. 

G-elsemium. — Dull, aching pains in the upper part of the 



78 NERVOUS THERAPEUTICS. 

spine, worse' after lying down ; pains shooting out from the 
spine to other parts, and sometimes in the opposite direction, 
causing the patient to cry out ; cerebrospinal congestions. 

Arnica. — Spinal congestion caused by overexertion, strain 
or mechanical injury; also when produced by the cold stage 
of intermittent fever. 

Lathyrus sat. — Numbness, followed by paralysis, of the lower 
extremities ; band feeling around the body ; patient unable to 
stand or take a step; sometimes unable to distinguish one 
limb from the other. 

Auxiliary Treatment. — The hot douche is one of the best 
local applications in this disease. The water, at a temperature 
of about 100° F., should be made to fall from a height of two 
or three feet over the affected part of the cord for a few 
minutes every day. Very satisfactory results sometimes follow 
the systematic administration of the constant current of elec- 
tricity, by passing it through the affected portion of the spine 
daily for a few minutes at a time, employing as strong a 
current for the purpose as the patient can conveniently bear. 
As soon as the numbness and hyperesthesia disappear, the 
induced current should be applied to the paralyzed muscles, 
to excite them to contract. 

SPINAL ANEMIA. 

Synonyms. — Anaemia of the Spinal Cord, Anaemia of the 
Anterolateral Columns, Spinal Paralysis, Spinal Exhaustion, 
Myelasthenia, Neurasthenia Spinalis, Reflex Paraplegia, In- 
hibitory Paralysis, Functional Paralysis of the Cord, Paralysis 
from Peripheral Irritation; Fr., Paraplegie Reflexe; Paraplegie 
Functionelle ; Ger., Reflex Paralysis Spinalis. 

Definition. — A disease characterized by such a general or 
local deficiency of blood in the vessels of the spinal cord as to 
impair its functions. 

Diagnosis. — Spinal anaemia may be distinguished from 
spinal hyperemia, first, by the fact that the symptoms, instead 
of being aggravated by the recumbent position, are always 
ameliorated by it; secondly, by the fact that it is not pro- 



SPINAL AN.KMIA. 79 

gressive; thirdly, when the bladder is involved it usually pre- 
cedes the paralysis. Ansemia of the antero-lateral columns is 
distinguished from that of the posterior columns by the absence 
o( any considerable disturbances of sensibility, and by the 
presence of well-marked, though incomplete, paraplegia. 

Pathology. — Reflex paraplegia and spinal neurasthenia are 
believed to be due to spinal anaemia because, there being no 
visible alterations of structure in these cases, the symptoms 
admit of no other rational explanation. The irritation is sup- 
posed to operate (1) upon certain sensory nerves which trans- 
mit the impression to the gray matter of the spinal cord, from 
which it is reflected (2) either along vaso-motor nerves regu- 
lating the caliber of the bloodvessels which supply either (a) 
the portion of the spinal cord in relation with the paralyzed 
parts, or else (b) the nerves of the paralyzed muscles them- 
selves. In either case the irritation is supposed to lead to a 
persistent spasm of certain vaso-motor vessels, so as to cause 
an anaemic condition of certain vascular territories in the 
spinal cord, or else of the related nerve-trunks and muscles, 
and thus, by interfering with the nutrition of the parts, de- 
prive them to a greater or less extent of their functions. 

Clinical Experience. — Nux vom., Phosphorus and Strychnia 
appear to be the remedies most frequently employed in this 
disease. Rhus tox., though it sometimes appears to help 
the paralytic condition, seldom does any permanent good in 
spinal anaemia. Arsenicum, China and Calcarea phos. are ex- 
cellent remedies, especially when the disease is associated with 
general anaemia, or with an impoverished condition of the 
blood. 

Therapeutic Indications. — Nux vom. — Great debility of 
the nervous system, with partial paralysis; reflex paralysis; 
paralysis from nervous exhaustion ; pain as from a bruise in the 
small of the back; heaviness and weariness in the lower ex- 
tremities; torpor of the liver, stomach and bowels; paralysis of 
the bladder. 

Phosphorus. — Bruised feeling in the back and limbs ; great 
heaviness and weariness from the least exertion ; spinal neu- 
rasthenia ; extreme mental and physical prostration. 



80 NERVOUS THERAPEUTICS. 

Strychnia phos. — One of the best remedies we have for anaemia 
of the cord ; paralysis from exhaustion of the reflex motor power 
of the spinal nerve-cells. 

Erythroxylon coca. — Sleeplessness and disinclination to work 
or move ; mental depression, with artxiety and palpitation of 
the heart ; loss of appetite ; constipation, with abdominal dis- 
tension ; oppression of breathing, arising from debility ; faint- 
ing fits from nervous weakness ; coldness of the extremities ; 
general debility, the least exertion being attended by fatigue. 

China. — Paralysis due to general anaemia or loss of vital fluids ; 
spinal anaemia following severe and exhausting illness ; neu- 
rasthenia spinalis induced by overexertion, either bodily or 
mental ; nervous trembling of the lower limbs. 

Arsenicum. — Paretic condition of the lower limbs, especially 
when associated with general anaemia; constant disposition to lie 
down; sensation of weakness in the small of the back'; para- 
lytic weakness preceded or accompanied by excessive or watery 
alvine discharges ; trembling of the limbs from debility ; rest- 
lessness, especially at night ; thirst for small quantities of water. 

Calcarea phos. — Coldness and weakness of the lower extrem- 
ities from defective circulation of blood in them ; nervous pros- 
tration, with great depression of spirits ; face pale and wan ; sore, 
bruised feeling in the back, with desire to lie down upon it. 

Kali phos. — Spinal anaemia from exhausting diseases ; reflex 
paraplegia, with burning pains, aggravated by rest, but worst 
on first moving about. 

Alumina. — Paralytic symptoms induced by cold, or when as- 
sociated with pain in the back; coldness of the surface ; weak- 
ness and heaviness in the lower extremities ; great exhaustion 
after slight exertions ; unrefreshing sleep ; weakness of the 
genito-urinary organs. 

Lycopodium. — Great nervous prostration ; neurasthenia from 
spinal anaemia ; flatulency ; constipation. 

Auxiliary Treatment. — Good, nutritious food, such as 
milk, eggs, beef, etc., and an abundance of fresh air and sun- 
shine, should always be provided. Change of climate and 
scenery, an ocean voyage, pleasant company, agreeable occupa- 
tion, etc., are often highly beneficial in these cases. Every 



SPINAL IRRITATION. 81 

source of peripheral irritation to which the patient is exposed 
should be removed or guarded against. Whatever benefits 
the genera] health will benefit the spine in these cases, and 
via versa. See Cerebrospinal ansemia. 

SPINAL IRRITATION. 

Synonyms. — Ansemia of the Posterior Columns of the 
Spinal Cord, Posterior Spinal Ansemia, Neuralgia of the Spine, 
Spinal Neuralgia, Rachialgia; Fr., Eachialgie; Ger., Rilck- 
gratschmerz. 

Definition. — A condition characterized by a greater or less 
degree of spinal tenderness, and by a morbid excitability of 
the nerves proceeding from the affected portion of the cord. 

Diagnosis. — Spinal irritation is liable to be mistaken for 
spinal hyperemia, hysteria, chronic myelitis and spinal men- 
ingitis. In spinal congestion there is, instead of hyperesthesia, 
more or less anaesthesia, numbness and formication; and when 
a sponge, dipped in hot water, is applied to the spine an 
intense aching is produced, which is not the case in spinal 
irritation. Chronic myelitis is characterized by anaesthesia, 
painful muscular contractions and paralysis — symptoms that 
do not belong to this disease. Spinal meningitis is a far more 
acute disease than spinal irritation, the hyperesthesia and 
pains on motion being very much more severe. Hysteria 
often resembles spinal irritation so closely as to be mistaken 
for it; and, indeed, it frequently coexists with it in the same 
patient. It may be best distinguished by the history of 
the case. 

Pathology. — Hammond and others regard spinal irritation 
as being essentially an anaemia of the posterior columns of the 
cord, basing their opinion on the following grounds: 1st, the 
general condition of the patient is one of debility, a condition 
which the exciting causes of the disease tend to produce; 2d, 
the symptoms indicate that the disease is seated in the posterior 
columns of the cord; 3d, whatever improves the quality of 
the blood, or increases the amount of it in the spinal vessels, 
always benefits the patient, and vice versa. Of course, it will 
only apply to those cases in which the nerves of sensibility are 



82 NERVOUS THERAPEUTICS. 

alone affected; when those of the motor sphere are implicated, 
the antero-lateral columns must be involved. But this view- 
appears to be too exclusive. Some cases are best explained 
by supposing that the two opposite conditions of hyperemia 
and anaemia coexist in different portions of the cord, while in 
others the symptoms appear to be due to hyperemia alone. 
It is generally conceded, however, that in the majority of 
cases the essential pathological condition is one of anaemia, 
involving the posterior columns of the cord. 

Clinical Experience. — The remedies which have proved 
curative in this disease are : Cocculus, Gelsemium, Cimicifuga, 
Strychnia phos., Hypericum, Belladonna, Tarantula, Secale cor., 
Natrum mar., Tellurium, Rhus tox., Ignatia and Scutellaria. In 
addition to these, the following remedies have benefited 
particular cases: Santonine, Silicea, China, Phosphorus, Sulphur, 
Zincum met., Calcis liypophos., Piper menth>, Naja, Veratrum vir., 
Calcarea carb. and iod., Nux vom., Colocynth., Kali hypophos., 
Agaricus and Aconite. 

Therapeutic Indications. — Cocculus. — Great hyperesthesia 
of all the senses, and an exalted susceptibility to impressions; 
dreadful headaches and sleeplessness; her sufferings are for- 
gotten when her mind is turned away from herself; pain in 
the lower portion of the spine ; stiffness of the neck ; palpitation 
of the heart and oppression of the chest; trembling of the 
limbs; numbness of the right upper and lower limbs. 

Gelsemium. — Stiffness and pain in the back of the head and 
neck; sleeplessness from soreness and pain in the back; great 
depression of spirits ; extreme weakness and prostration. 

Cimicifuga. — Severe aching pain in the lower part of the 
back and in the occiput, with occasional shooting pains in the 
chest, and great weakness, amounting almost to paralysis, of 
the lower extremities; constant nausea and retching on press- 
ure upon the spine, between the fourth and fifth vertebrae ; fre- 
quent fainting; palpitation on least movement; amenorrhcea; 
aggravated by cold, movement, and at the menstrual period. 

Strychnia phos. — Tenderness on pressure over the dorsal 
vertebrae; pain, sometimes burning, but chiefly aching, ex- 
tending frequently to the front of the chest, causing a feeling 



SPINAL [RRITATION. 83 

o( uneasiness and nausea; cold feet, covered with clammy 
perspiration ; insomnia. 

Hypericum. — Tenderness of the whole spine ; pain in the 
joints, accompanied by mania; laming-aching in the dorsal 
region ; frightful illusions, screaming if approached ; no recol- 
lection of the attack ; stiches and paroxysms of pain in different 
parts of the body. 

Belladonna. — Pressure over the dorsal vertebras causes her 
to cry out and turn pale and nauseated; continual burning 
pain in the spine; tenderness of the stomach, with nausea and 
vomiting on eating; pressure on the fourth dorsal vertebra 
produces a shriek, followed by a dry, violent cough, red face, 
headache in forehead, photophobia and perspiration. 

Tarantula. — A slight touch along the spine causes spasmodic 
pains in the chest and great distress in the cardiac region; 
also cardiac disturbances, intense headache and sensation of 
burning all over the body; muscular contractions; convulsive 
movements, tremblings and general chilliness. 

Secale cor.— Tenderness over the superior spinous processes, 
with stiffness of the neck; pains radiate from the affected 
portion of the spine to the chest, producing anxious, oppressed 
breathing, with palpitations, and tendency to convulsive 
movements and cough. 

Natrum mur. — Sensitiveness of the spine, with pain in the 
back; eyes sore on pressure; supraorbital neuralgia, with 
nausea and sensitiveness to bright lights; vision clouded with 
black spots; hemiopia; sleeplessness; morning headache; 
anorexia; constipation; restlessness and debility. 

Tellurium. — Tenderness of the spine, with extreme sensitive- 
ness to pressure; patient so sensitive and irritable as even to 
dread the approach of any one. 

Rhus tox. — Violent pain in the head and down the back, 
with extreme sensitiveness of the spine to pressure; lies on her 
back with the head and spine drawn backward; the slightest 
touch or movement causes extreme pain; anxious, oppressed 
breathing, with violent palpitations, occurring in paroxysms; 
complete sleeplessness. 

Ignatia. — Aching pain as if bruised in the cervical and 



84 NERVOUS THERAPEUTICS. 

dorsal portions of the spine; lancinating pain in the nape of 
the neck, also in the small of the back, extending through the 
loins; pains increase by pressure over the spine; cases com- 
plicated with hysteria. 

Auxiliary Treatment. — The Weir Mitchell treatment of 
absolute rest, combined with gentle galvanization of the spine 
by the constant current, positive pole below, negative above, is 
perhaps the best local treatment, in most cases, when it can be 
rigidly carried out; but where reflex excitations to distant 
parts, causing palpitations, neuralgia, congestion and engorge- 
ment of pelvic and abdominal organs, etc., are due to engorge- 
ment of the cord, rather than to anemia, cold to the spine is 
found to be eminently remedial. Other cases, on the contrary, 
are benefited by hot ivater to the spine. The diet should in all 
cases be generous. 

SPINAL HEMORRHAGE. 

Synonyms. — Haemorrhage into the Spinal Cord or its 
Membranes, Spinal Apoplexy, Haemorrhagia Medulla Spi- 
nalis, Haem atomy elia ; Fr. } Hemorrhagic Intrarachidienne, Hem- 
atomy ele, Apoplexie de la Moelle Epiniere ; Ger., Riickenm,arks~ 
apoplexie. 

Definition. — Haemorrhage into either the substance of the 
cord or into its membranes, to which latter variety most cases 
of spinal haemorrhage belong. 

Diagnosis. — Usually, the chief reliance must be upon the 
history of the case, the existing symptoms affording but few 
diagnostic marks. When, however, paraplegia occurs sud- 
denly, and is the result of an accident, we shall generally be 
warranted in attributing the paralysis to spinal haemorrhage. 

Pathology. — When effused into the substance of the cord, 
the clot, which is almost invariably seated in the gray matter, 
shows a greater tendency to extend in the course of the long 
axis of the cord than laterally, and varies in length from 
half an inch or less to several inches, sometimes involv- 
ing the entire central portion of the cord. In the meningeal 
variety the blood is generally extra vasated between the bones 



SPINAL MENINGITIS. 85 

and the dura mater, but very rarely it is effused into the pia 
mater, where it more or less compresses the cord and produces 
the anaesthesia and motor paralyses observed in such cases. 
When the extent and situation of the haemorrhage are such as 
to cause irritation instead of compression, the effect is to pro- 
duee hyperesthesia and spasm. 

Clinical Experience — Hypericum, Arnica and Calendula are 
given after severe injury to the spine followed by numbness 
and paralysis, with a view to promote the absorption of any 
clot which may have formed and is causing compression. 
Secale cor. is given to prevent further effusion by contracting 
the spinal bloodvessels. 

Therapeutic Indications. — These are given under the 
heads of cerebral hemorrhage, spinal paralysis and ansesthesia, 
which see. 

Auxiliary Treatment. — Whenever there is reason to appre- 
hend the existence of spinal haemorrhage, ice should be applied 
to the spine and the patient made as quiet and comfortable 
as. possible. Absolute rest is essential, not only to prevent fur- 
ther effusion of blood, but to render the consequences of the 
haemorrhage as light as possible. 

SPINAL MENINGITIS. 

Synonyms. — Inflammation of the Spinal Meninges, Menin- 
gitis Spinalis ; Fr., Meningite Spinale. (1). Dura Mater : 
Spinal Pachymeningitis; Fr., Fachymeningite Spinale; (2). 
Arachnoid: Spinal Arachnitis; Fr., Arachnite Spinale; (3). 
Pia Mater : Spinal Leptomeningitis ; Fr., Leptomeningite Spi- 
nale ; Get., Riickenmarkshautentzilndung. 

Definition. — Inflammation involving one or more of the 
membranes of the cord. As it is usually limited to the soft 
membranes, it is immaterial whether we call the disease 
spinal meningitis or spinal leptomeningitis. 

Diagnosis. — The diagnosis of spinal meningitis, either 
acute or chronic, depends upon the presence of the following 
symptoms: (1) pains in the back and limbs, greatly aggra- 
vated by every movement of the spine ; (2) muscular rigidity 



86 NERVOUS THERAPEUTICS. 

similar to, but less severe and general than, that of tetanus ; (3) 
hyperesthesia and increased reflex excitability; and (4) reten- 
tion of urine and faeces, followed by more or less paralysis, 
anaesthesia and incontinence of urine and faeces. The absence 
of cerebral symptoms is sufficient evidence that the disease is 
not tubercular. 

Clinical Experience. — The remedies which appear to stand 
the highest in the treatment of this disease are : Aconite, Bella- 
donna, Bryonia and Nux vom.. Others which have received 
clinical indorsement are : Rhus tox., Causticum, Plumbum, Hy- 
pericum, Cuprum, Veratrum vir., Mercurius, Secale cor. and 
Oxalic ac. 

Therapeutic Indications. — Aconite. — High fever, with bor- 
ing pain in the spine, increased on motion; painful stiffness 
in the dorsal region, extending to the neck; numbness extend- 
ing from the small of the back into the lower limbs ; formica- 
tion in the arms; spasms caused by spinal inflammation; 
insensibility and coldness of the hands and feet; the arms 
hang powerless, as if paralyzed. 

Belladonna. — Lancinating pains in the vertebrae, resembling 
stabs with a knife ; tonic muscular contractions ; cramplike 
pain in the middle of the spinal column ; painful stiffness in 
the back of the neck ; intense dyspnoea, as if the chest were 
violently compressed ; complete or incomplete paralysis, with 
or without incontinence of urine. 

Bryonia. — Sticking pains in the back on the slightest move- 
ment of the spine; promotes absorption of serous effusion, and 
thus relieves paralysis from compression ; sticking pains in 
the chest, with fever. 

Nux vom. — Violent pains in the back, especially in the dorsal 
and lumbar regions; pains extending from the back to the 
sternum, producing shortness of breath; pains aggravated 
by movement; hypochondriac and epigastric regions sensitive to 
pressure; numbness and weakness of the arms and legs; reten- 
tion of urine ; constipation. 

Hypericum. — Fever, with wild, staring looks, hot, bloated 
face, thirst and white-coated tongue ; painfulness of the back 
from injury to the spine, greatly increased by any movement 



SPINAL MENINGITIS. 87 

of the body ; the slightest movement of the spine extorts cries ; the 

cervical vertebra' sensitive to the touch; spells of short, hack- 
ing cough and difficult breathing; desire for warm drinks. 

Plumbum. — Chronic cases, attended with frequent attacks of 
violent colic, with retraction of the abdominal walls; paralyzed 
parts greatly emaciated ; limbs become painfully contracted ; 
coldness and paralysis of all the limbs, especially of the lower; 
extreme constipation. 

Cuprum. — Suffocative breathing from spasm of the respiratory 
muscles; rigidity, with painful contractions of the limbs, toes 
and fingers; excessive weakness, especially in the lower ex- 
tremities ; painful jerkings in various parts of the body and 
limbs ; paralysis, with incontinence of urine. 

Rhus tox. — High fever from getting wet, or from repercussion 
of an exanthem ; numbness, and loss of sensibility and power 
of motion in the limbs; formication; dyspnoea; inflammation 
following concussion of the spine. 

Secale cor. — Spinal meningitis, attended with suppression of 
urine; spasms, followed by paralysis, numbness and insensi- 
bility. 

Mercurius. — Violent pain in the spine, aggravated by motion; 
great restlessness and sleeplessness at night, or when warm in 
bed ; paralysis of the lower limbs, bladder and rectum ; anaes- 
thesia of the skin ; occasional jerks in the paralyzed parts. 

Physostigma. — Spinal meningitis, with tetanic spasms ; back 
very weak ; stiffness and pain all along the spine, with incli- 
nation to bend forward ; stiffness of the neck, with feeling of 
drawing and tension. 

Stramonium. — Constant pain in cervical and upper dorsal re- 
gions of the spine, which is sensitive to the touch ; sudden 
jerks through the body ; tonic spasms, with consciousness un- 
affected ; muscles ivill not obey the will; trembling contractions. 

Cicuta. — Violent spasmodic pains in the paralyzed lower 
limbs; trembling of the limbs during remission: painful stiff- 
ness in the muscles ; frequent involuntary jerking and twitch- 
ing in the limbs, followed by paralysis ; feeling of soreness in 
many parts of the body. 

Kali iod. — Constant violent pain in the small of the back ; 



OO NERVOUS THERAPEUTICS. 

spasmodic contraction of the muscles; fever, with excessive thirst; 
burning sensation at the pit of the stomach ; great desire to go 
into the open air ; paralysis of the lower extremities. 

Auxiliary Treatment. — Ice to the spine usually gives most 
relief in acute cases, especially to the pains. Chronic cases are 
benefited by the primary galvanic current and by the electro- 
cautery. The patient should lie on his side or face, on a com- 
fortable spring mattress, in a large, quiet, airy room. Animal 
broths, soups, milk, eggs and other nutritious articles of food 
should constitute the diet, strengthened, when required, by a 
moderate allowance of stimulants. Bed-sores should be pre- 
vented as long as possible, and after they have formed they 
should receive careful attention. A mild current of electricity 
passed daily through the affected parts will often cause them 
to heal. Great care should also be taken to relieve the blad- 
der and rectum, especially after paralysis has occurred. 

MYELITIS. 

Synonyms. — Inflammation of the Spinal Cord, Inflamma- 
tory Softening of the Cord, Myelitis Acuta ; Fr., My elite, Inflam. 
de la Moelle Epiniere, Ramollissement de la Moelle Epiniere; Ger., 
Rilckenmarksentzundung, Erweichung des Ruckenmarks. 

Definition. — An acute inflammation of the whole, or of any 
part, of the substance of the spinal cord. 

Diagnosis. — The history of the case, especially in traumatic 
injuries, is often sufficient of itself to determine the diagnosis. 
The disease may also be distinguished from other affections of 
the spine by the characteristic symptoms of the disease, such 
as the "band feeling" about the body and the rapid develop- 
ment of paraplegia, together with the reflex phenomena of pain 
and convulsive movements. 

Pathology. — The essential pathological feature of acute 
myelitis consists in hypertrophy of the neuroglia, and conse- 
quent atrophy or degeneration of the nervous elements of the 
cord, resulting finally in inflammatory softening, or else in 
sclerosis. 

Clinical Experience. — The remedies most frequently em- 



MYELITIS. 80 

ployed in myelitis are: Aconite, Gelsemium, Belladonna and 
Mercurius in recent cases; and Arsenicum, Plumbum, Oxalic ac. 
and Strychnia in chronic cases. Arnica, Hypericum, Rhus. tox. 
and Sulphur are most frequently given in traumatic cases. 

Therapeutic Indications. — Aconite. — Acute cases, attended 
with high fever, spasms, numbness, formication, icy coldness 
of hands and feet. Push the remedy to the extent of produc- 
ing a profuse perspiration. 

Gelsemium. — Cerebro-spinal symptoms, such as confusion of 
the head, extending from the occiput to the forehead ; paresis 
of tongue and glottis ; pains in the back of the head and spine, 
with pains darting laterally from the latter to other parts ; 
spinal exhaustion ; loss of voluntary motion ; incontinence of 
urine; myelitis involving the anterior horns of gray matter. 

Belladonna. — Both acute and chronic cases, where there are 
pains in the back, with weakness and weariness ; paralysis of 
the ocular muscles and iris ; partial or general paralysis ; dysp- 
noea ; tonic and clonic spasms ; chronic cases caused by retro- 
cession of eruptions. 

Mercurius. — Great restlessness and sleeplessness, especially at 
night ; pains in the spine, violent, and worse from motion ; 
paralysis and anaesthesia of the lower limbs ; occasional jerking 
in the paralyzed muscles. 

Plumbum. — Chronic cases, especially when attended by colicky 
pains ; painful tonic contractions ; paralyzed parts become 
greatly emaciated ; dyspnoea from hyperesthesia of the inter- 
costals ; atrophy of the muscular tissues ; extreme constipation. 

Arsenicum. — Chronic cases attended by great dyspnoea and 
anxiety ; twitching, trembling, violent starting and weariness 
in the limbs ; tetanic spasms; great restlessness, especially at 
night, with sleeplessness. 

Angustura. — Twitching and jerking along the back like elec- 
tric shocks; tonic contraction of the muscles of the jaw; 
bruised pain in the dorsal region, or in the muscles of the 
neck ; tension of the facial muscles ; tremulous stitches in the 
thighs. 

Secale cor. — Violent pains in the back, especially in the sacral 
region ; muscular twitching and jerking in the limbs ; tingling 



90 NERVOUS THERAPEUTICS. 

in the back, extending to the fingers and toes ; painful contrac- 
tion of the flexor muscles ; paralysis and anaesthesia of the 
limbs ; especially indicated in cases complicated with spinal 
meningitis. 

Causticum. — Lancinating pains in the back, arresting the 
breathing ; numbness and insensibility of the fingers and toes, 
with ice-cold sensation and tendency to cramp. 

Veratrum alb. — Aching and sticking pains in the back ; 
tingling in the hands ; painful jerking in the limbs ; cramps 
in the legs ; paresis. 

Arnica. — Subacute and chronic cases of traumatic origin ; 
should be given previous to the setting in of the degenerative 
process. 

Phosphorus. — Chronic cases resulting from sexual excesses, or 
where there is a tubercular condition of the system; paroxysmal 
pains in the back, with paralytic weakness ; dyspnoea, with 
sensation as if the chest was oppressed by a load resting upon 
it. 

Picric ac. — Tonic and clonic spasms ; extreme iveariness and 
exhaustion ; tendency to softening of the cord ; great chilliness, 
can't get warm ; sensation of worms crawling over the ears ; 
paralysis. 

Oxalic ac. — Limbs stiff, numb, weak, heavy, powerless; 
muscular twitchings ; acute pain in the back, with numbness 
and weakness, extending to the limbs ; pains excited and 
aggravated by movement ; they are usually like short stitches, 
confined to a small spot, and lasting only a few seconds. 

Auxiliary Treatment. — This is similar to that recom- 
mended under the head of spinal meningitis, which see. Kafka 
also advises the spray douche, frequently repeated, to the 
spinal column. 

MYELOMALACIA. 

Synonyms.— Softening of the Spinal Cord, Simple, White, 
Non-inflammatory Softening, Mollities Medullse Spinalis ; Fr., 
Ramollissement de la Moelle Epiniere ; Ger., Eriveichung des 
Ruckenmarks. 



MYELOMALACIA. 91 

Definition. — A primary, non-inflammatory, and apparently 
idiopathic, softening of the spinal cord. 

Diagnosis. — The condition, in striking contrast with every 
other affection of the cord, is best known by its negative symp- 
toms, there being no pains or exalted sensibility, nor any 
muscular twitchings, spasms or contractions, even when the 
whole structure of the cord is involved in the process. 

Pathology. — Some writers still adhere to the old notions 
concerning softening of the cord, regarding as inflammatory 
not only the forms resulting from the so-called acute central 
myelitis and myelitis diffusa, but also the large class of 
primary softenings, due chiefly to vascular disturbances, and 
which belong to the degenerative type of diseases. Even 
secondary degenerations of the cord are sometimes classed as 
inflammatory, notwithstanding the fact that hyperplasia of the 
neuroglia subsequently sets in, giving rise to sclerosis. There 
is, however, but one true form of inflammatory softening, 
namely, that resulting from acute myelitis. All others belong 
to the category of non-inflammatory softenings, and constitute 
the simple white softening known as myelomalacia, in which 
the tissues of the cord are found to have undergone fatty and 
granular degeneration, the constituents consisting chiefly of 
oil-globules, debris of nervous matter, and broken-down con- 
nective tissue. (Further information on this subject may be 
obtained by consulting the author's article on " Diseases of the 
Nervous System " in Arndt's System of Medicine, Vol. II, pp. 
610, 614.) 

Clinical Experience. — All the clinical experience we have 
on this subject is given under the head of myelitis, which see. 
Picric ac. will produce softening of the cord, but whether it is 
capable of restoring the degenerated cord to a state of integrity 
is another question, and remains to be proved. 

Therapeutic Indications. — These are given under the 
heads of spinal hyperemia, myelitis and spinal paralysis, which 
see. 

Auxiliary Treatment. — Hopeless as may be the case, so 
far as a cure is concerned, much may be done toward render- 
ing the patient more comfortable and prolonging his life. 



92 NERVOUS THERAPEUTICS. 

Thus, the weakened cord should be guarded against any 
further injury by carefully avoiding any sudden jar or fall ; 
bed-sores should be prevented or promptly and methodically 
treated; and the bladder should be emptied with regularity, 
either spontaneously or, as will generally be required, by 
means of the catheter. Passive exercise in the open air should 
be taken as long as practicable ; and in no case should the 
patient be unnecessarily deprived of fresh air and sunshine, 
which are no less essential to his support than good and 
wholesome food. 

SPINAL PARALYSIS. 

Synonyms. — Paralysis of the Spine, Spinal Palsy, Para- 
plegia, Paraplexia; Fr., Paraplegie, Paralysie Spinale; Ger., 
Paralysis Spinalis, Spinalparalysie, Spinallakmung. 

Definition. — Paralysis of the lower extremities, with or 
without paralysis of the lower part of the trunk, bladder and 
rectum. 

Diagnosis. — There are three distinct forms of organic 
paralysis depending on the seat of the disease, namely, the 
hemiplegic or cerebral, the paraplegic or spinal, and the general 
or cerebro-spinal. To these may be added the reflex or peri- 
pheral, which usually assumes the paraplegic form, and may 
be known partly by the absence of the distinctive symptoms of 
organic paralysis, and partly by the rapid improvement which 
usually attends the removal of the irritation which causes it. 

Pathology. — The pathological' changes which characterize 
the various forms of organic paraplegia will be given in the 
succeeding articles treating of the different varieties of spinal 
paralysis, which see. Toxic and reflex paraplegias exhibit no 
pathological alterations, being simply due to vaso-motor spasm 
caused by disease or injury of remote organs, without any 
appreciable evidences of organic disease in the cord or its 
membranes. 

Clinical Experience. — Reserving for special mention under 
their appropriate heads the clinical experience pertaining to 
the several forms of organic paraplegia, we shall here give 
only what relates to the toxic and reflex varieties, viz. : 



SPINAL PARALYSIS. 03 

(a) Toxic Paralysis. 

When caused by lead poisoning: Kali iod., Opium, Cupr., 
Plat. 

When caused by mercury: Nitric ac, Sulph., Hepar sulph., 
St ram.. Staph. 

When due to arsenical poisoning: Ferr., Chin., Hepar sulph., 
Nux vom., Graph. 

(b) Reflex Paralysis. 

When caused by worms: Cina, Santonine, Tereb., China, Ign., 
Cicuta. 

When due to dental irritation : Cham., Bell., Gels., Aeon., 
Hyos., Stram., Cupr., Ign., Cicuta. 

When produced by intestinal irritation : Merc, Arsen., China, 
Phos. ac., Baptis., Ipec, Verat., Calc. 

When due to genito-urinary irritation: Bell., Apis, Canth., 
Dulc, Equise., Hyos., Gels., Lycop., Cactus. 

When caused by diphtheria: Gels., Arsen., Natr. mur., Rhus 
tox., Lach., China, Phos., Kali phos., Nux vom., Ferr. 

When caused by cold or dampness : Dulc., Gels., Rhus tox., 
Apis, Verat,, Bell. 

When due to external injury: Arnica, Hyper., Cicuta, Rhus 
tox., Sulph. 

When caused by pleurisy or pneumonia : Bry., Phos., Tartar 
einet., Sang., Sulph. 

When due to sexual excesses : Helonias, Agnus cast., Phos., 
Nux vom., China, Pic. ac, Nit. ac, Dios., Sarsap., Aurum, 
Sepia. 

When due to exhausting diseases : China, Phos., Arsen., Zinc. 
phos., Pic. ac, Calc, Carbo veg., Phos. ac, Nux vom., Calc. 
hypophos. 

Therapeutic Indications. — These will be found under the 
various forms of paralysis hereafter to be described. See, 
also, spinal meningitis, myelitis, locomotor ataxia and spinal 
concussion. 



94 NERVOUS THERAPEUTICS. 

ACUTE ASCENDING PARALYSIS. 

Synonyms. — Acute Progressive Paralysis, Landry's Paraly- 
sis, Paralysis Ascendens Acuta ; Fr., Paralysie Ascendante Aigu< ; ; 
Ger., Paralysis Ascendens Acuta. 

Definition. — An acute disease of the spinal cord, character- 
ized by a rapidly progressive paralysis, and unattended by any 
appreciable lesion. 

Diagnosis. — This disease may be distinguished from the 
" acute spinal paralysis of adults," and also from subacute 
forms of spinal paralysis, (1) by the absence of rapid muscular 
atrophy, and (2) by the fact that the electrical excitability of 
the muscles is unimpaired. Moreover, the disease is regularly 
progressive in its character, in which respect it differs from 
acute spinal paralysis, where the impairment of muscular 
power occurs simultaneously in every part affected. 

Pathology. — No pathological changes, not. even hyperemia, 
have yet been discovered after death by this disease, either in 
the cord or in its membranes. The disease is supposed to be 
due to some peculiar disturbance of nutrition. 

Clinical Experience. — Aluminum, met, Ledum, Cocculus and 
Gelsem.ium occupy the first rank in this disease, and Pliosphorus, 
Bhus tox., Nux vom. and Secale cor. the second. 

Therapeutic Indications.— Aluminum met. — While the 
paralysis is confined to the lower limbs, or when there is so 
much heaviness of the legs that the patient is scarcely able to 
lift them, or when they are so weak that he is obliged to sit 
down, and experiences great weariness even when sitting; 
staggers in walking; numbness of heel and pain in the sole of 
the foot when stepping ; constant inclination to lie down. 

Ledum. — Paralysis ascending from the feet upward ; pains in 
the soles of the feet when walking ; sensation as if the posterior 
muscles of the thighs were paralyzed. 

Cocculus. — Paraplegia occurring in debilitated nervous per- 
sons, and where the circulation is impeded or sluggish ; gen- 
eral sense of prostration from paralysis of organic life ; sense of 
constriction through the whole spine. 

Grelsemium. — General sense of helplessness, arising from the 



SPINAL PARALYSIS OF ADULTS. 95 

muscles not obeying the will-power of the patient; complete re- 
laxation of the whole muscular system; pain in the back of the 
head and neck; dimness of vision; great drowsiness. 

Picric ac. — I believe this to be the nearest similium we have ; 
the great sense of prostration and the acuteness of the symp- 
toms appear to call for it, but it should be used comparatively 
high ; it ought to cure in the 30th potency. 

Nux vom. — Paretic condition, in which the power of voluntary 
motion is not wholly lost ; feeling of great weakness, especially 
in the back; staggers in walking, and sometimes falls; paral- 
yzed parts numb and cold; paralysis from exhaustion of the 
spinal cord ; drags his feet in walking. 

Rhus tox. — Paraplegia attended with painful stiffness, ting- 
ling and numbness in the paralyzed limbs ; pain in the back 
ameliorated b} T lying on something hard ; paralysis of the rec- 
tum and bladder, as well as of the lower extremities. 

Phosphorus. — Where the paralysis seems to depend on per- 
verted nutrition ; pains in the soles of the feet, with sensation 
as if they were asleep ; insupportable pains in the spine, pre- 
venting walking ; partial contraction of the affected muscles, 
with formication and tearing pains. 

Secale cor. — Severe spinal pains, especially in the sacral re- 
gion ; paralysis of the lower sphincters ; destroys the activity of 
the cord. 

Auxiliary Treatment. — The majority of cases are so acute 
that but little good can be expected of accessory treatment. 
The constant galvanic current to the spine may, however, 
prove to be of some benefit, if methodically applied. 

SPINAL PARALYSIS OF ADULTS. 

Synonyms. — Atrophic Spinal Paralysis, Inflammation of 
the Anterior Horns, Poliomyelitis Anterior ; Fr., Paralysie 
Spinale Atrophique, Paralysie Spinale de VAdulte ; Ger.,Spinallah- 
mung hex Erwachsenen, Poliomyelitis Anterior. 

Definition. — A peculiar form of paralysis in the adult, 
acute, subacute or chronic, resulting from inflammation and 
degeneration of the gray matter of the anterior horns of the 



96 NERVOUS THERAPEUTICS. 

spinal cord, and followed by more or less atrophy of the 
paralyzed muscles. 

Diagnosis. — The regressive character of the muscular 
weakness and paralysis, almost, if not wholly unattended by 
febrile symptoms, but accompanied by wasting of the limbs, 
by abolition of the patellar tendon reflex, and by sensations 
of numbness, yet without loss of tactile sensation, and without 
paralysis of the bladder or rectum, will render the diagnosis 
clear and indisputable. It may be distinguished from that 
form of peripheral neuritis which is attended by paralysis and 
muscular atrophy, by means of the following table: 



Poliomyelitis. 


Peripheral Neuritis. 


Disease usually begins suddenly. 


Sets in gradually. 


Paralysis regressive. Involves at the 


Paralysis progressive. Involves differ- 


start all the members affected, some 


ent members, generally in the na- 


parts quickly recovering. 


ture of an ascending palsy. 


Usually no pain. May be general 


Pain is usually continuous; especially 


hyperesthesia at the beginning. 


marked upon handling, and in- 




volves certain nerves. 


Muscles not sensitive to pressure. 


Muscles sensitive to pressure. 


No recovery after the disease has lasted 


Perfect recovery may take place after 


some time. 


the paralysis and atrophy have 




lasted a long time. 



Pathology. — The pathological changes in the cord are 
chiefly confined to the anterior horns of gray matter, and 
consist in atrophy and yellow pigmentation of the motor 
nerve-cells, and in centres of softening, showing that the 
disease is essentially a myelitis. Whether, as Hammond 
supposes, the muscular atrophy is due to the destruction of 
trophic cells in the cord, of the existence of which we have 
no other evidence, or whether, with Charcot, we refer it to 
atrophy of the motor cells alone, there can be no doubt of its 
dependence on the spinal affection, which is always associated 
with it. 

Clinical Experience. — The remedies which seem to have 
done the most good in this disease are: Gelsemium, Belladonna, 
Aconite, Phosphorus, Strychnia, Rhus tox. and Argentum nit. 



INFANTILE SPINAL PARALYSIS. 



97 



Therapeutic Indications. — These have already been given 
under the head of myelitis, which see. Consult, also, spinal 
hyperemia, spinal meningitis and progressive muscular atrophy. 

Auxiliary Treatment. — After the inflammatory process 
has been arrested, the paralyzed and atrophied muscles should 
be stimulated to contract by the methodical application of 
electricity. Massage is also useful in these cases, especially the 
electro-massage of Dr. Butler. 



INFANTILE SPINAL PARALYSIS. 

Synonyms. — Essential Paralysis of Childhood, Antero- 
spinal Paralysis of Infancy ; Fr., Paralysie Essentielle de V En- 
hance, Paralysie Atrophique Graisseuse de VEnjance; Ger., Spinale 
KinderUihmung. 

Definition. — An acute disease of the spinal cord in chil- 
dren, characterized by the three successive stages of fever, mus- 
cular paralysis and atrophy. 

Diagnosis. — The fact that progressive muscular atrophy 
sometimes attacks children has led occasionally to the mistake 
of confounding it with this disease, from which it may be 
differentiated as follows: 



Infantile Spinal Paralysis. 


Progressive Muscular Atrophy. 


Causes unknown. 


Heredity in some cases ; in others, ex- 




posure to wet and cold and exces- 




sive muscular exertion. 


Patients, infants and children. 


Mostly adults. 


Always acute. 


Always chronic. 


The paralysis appears first, and is fol- 


The atrophy appears first, and the mus- 


lowed later by muscular atrophy. 


cular weakness and paralysis de- 




pend upon its extent. 


Course of the atrophy stationary or re- 


Always progressive. 


gressive. 




Electrical reaction corresponds to the 


Electrical irritability altered according 


degeneration of the cord. 


to the extent of the muscular 




atrophy. 



Pathology. — As in spinal paralysis of adults, the essential 
lesion in this disease is found to be situate in the anterior 



98 NERVOUS THERAPEUTICS. 

horns of gray matter, and to consist of a myelitis, which 
results in an atrophy of the part affected, a degeneration of its 
structure and a disappearance of its cell-elements. 

Clinical Experience. — Gelsemium, Rhus tox., Belladonna, 
Atropine, Nux vom., Strychnia and Cocculus are preferred in the 
more acute, and Phosphorus, Secale cor. and Plumbum in the 
less acute cases. 

Therapeutic Indications. — These have already been given 
under the head of myelitis, which see. Consult, also, spinal 
hyperemia, spinal meningitis and progressive muscular atrophy. 

Auxiliary Treatment. — Dr. Mossdorf claims to have treated 
a large number of cases successfully with the descending cur- 
rent of central galvanization of the spinal cord. In some cases 
over one hundred applications were made before motility was 
restored. So long as the paralyzed muscles retain their electro- 
contractility the treatment by electricity may be made effec- 
tive. The number of cells to be. used is best determined by 
trial. The positive electrode should be placed over the nerve - 
trunks supph T ing the atrophied muscles, and the negative 
upon the affected muscles themselves, interrupting the current 
from time to time by slowly lifting and replacing the negative 
sponge. 

Should the physician be called during the acute or inflam- 
matory stage, the cold douche, frequently applied to the spine, 
will be of benefit. 

PSEUDO-HYPERTROPHIC SPINAL PARALYSIS. 

Synonyms. — Pseudo-Hypertrophic Muscular Paralysis, 
Lipomatosis Musculorum Luxurians, Atrophia Musculorum 
Lipomatosa; Fr., Paralysie Pseudo-Hypertrophique, Paralysie 
Myosclerosique, Paraplegic Hypertrophique de VEnfance; Ger., 
Muskel-atrophie mit Inter stitieller Lipomatose. 

Definition. — A progressive paralysis, belonging almost ex- 
clusively to infancy and childhood, caused by inflammation of 
the anterior tract of gray matter of the spinal cord, in which 
certain muscles appear to be hypertrophied, although the 
ultimate fibres of the affected muscles atrophy. 



GLOSSO-LABIO-LARYNGEAL PARALYSIS. 99 

Diagnosis. — The gradually advancing paralysis of the lower 
extremities, accompanied by an enlargement of the gastroc- 
nemii muscles, and afterward of those of the thigh and gluteal 
region, will serve to distinguish it from every other affection. 

Pathology. — The pathological changes in the cord consist 
in atrophy and disintegration of the nerve-cells of the anterior 
horns, and sclerosis of the lateral columns. The muscular 
hypertrophy appears to be due to proliferation of the adipose 
and connective tissues, probably in consequence of morbid 
nutrition. 

Clinical Experience. — Argentum nit. and Phosphorus are 
the only two remedies that have so far proved to be of any 
special value in this disease. 

Therapeutic Indications. — These will be found under the 
heads of myelitis and spinal sclerosis, which see. Consult, also, 
spinal hyperemia and progressive muscular atrophy. 

Auxiliary Treatment. — Duchenne is said to have cured 
two cases of this disease with the induced current, but others 
have not been so fortunate. Improvement, however, has fol- 
lowed the application of the primary current to the spine and 
the faradaic current to the affected muscles; in one case even 
where there were extreme atrophy of the extremities and 
absolute loss of muscular contractility to both currents, until 
after many weeks of constant effort there was produced a slight 
reaction, followed by increasing improvement up to approxi- 
mate recovery. 

GLOSSO-LABIO-LARYNGEAL PARALYSIS. 

Synonyms. — Duchenne's Disease, Labio-Glosso-Pharyn- 
geal Paralysis, Progressive Glosso-Labio-Laryngeal Paralysis, 
Progressive Bulbar Paralysis, Myelitis Bulbi ; Fr., Paralysie 
Ghsso-Labio-Laryngee ; Ger., Progressive Bulbarparalysie. 

Definition. — An acute or chronic, progressive and sym- 
metrical paralysis of the lips and adjacent facial muscles, of 
the tongue, pharynx, and sometimes of the larynx, with or 
without conspicuous muscular atrophy. 

Diagnosis. — Progressive muscular paralysis sometimes 



100 NERVOUS THERAPEUTICS. 

resembles this disease, especially when the tongue is first 
involved, but that affection seldom commences in these parts, 
and never until after atrophy has set in. Facial paralysis 
might be carelessly mistaken for this disorder, but facial 
paralysis is confined to the parts animated by the facial nerve, 
whereas in this disease only the muscles of the lower part of 
the face are affected. 

Pathology. — The microscope shows that there is degenera- 
tion of the ganglion-cells in the motor nuclei of the hypo- 
glossus, portio-dura, spinal accessory and pneumogastric 
nerves, the nucleus of the cell being destroyed and its place 
supplied by numerous brown granules. Chronic sclerosing 
myelitis has also been observed at the points of origin of these 
nerves, in the medula oblongata and upper part of the spinal 
cord, the nerve fibres being reduced in size and number, their 
contents in a state of fatty and granular degeneration, and the 
cylinder axis either atrophied or hypertrophied. The wasting 
of the ganglion cells is not always in proportion to the atrophy 
of the affected muscles, a fact which Duchenne and others 
attempt to explain by supposing that the ganglion cells in the 
motor nuclei are partly motor and partly trophic. 

Clinical Experience. — Anacardiurn and Argentum nit. are 
said to have cured bulbar paralysis, but I am obliged to con- 
fess that I have obtained but little benefit from either of these 
remedies in this formidable complaint. Baryta and Phos- 
phorus have also been recommended. I recently had an 
opportunity of trying Plumbum, and for a time it seemed to 
arrest the progress of the disease, but finally neither it nor 
any other remedy seemed to do any material good. I am 
strongly of the opinion, however, that if the remedy had been 
given from the time the disease first made its appearance it 
would have proved more effective. 

Therapeutic Indications. — These will be found under the 
heads of myelitis and posterior spinal sclerosis, which see. 

Auxiliary Treatment. — But little can be done, in the way 
of accessory treatment, to benefit the patient. Electricity, 
though unsuccessful as a curative agent, has seemed to do 
some good in lessening the suffering, especially in relieving 



PROGRESSIVE MUSCULAR ATROPHY. 101 

the sense of constriction in the throat and chest. The food, 
which should he both nourishing and easily digestible, requires 
to be reduced to a semi-solid condition before any attempt is 

made at swallowing it. 

PROGRESSIVE MUSCULAR ATROPHY. 

Synonyms. — Wasting Palsy, Myopathic Paralysis, Amyo- 
trophic Paralysis, Cruveilhier's Atrophy, Progressive Poly- 
myositis, Paralysis Atrophica ; Fr., Atrophie Musculaire Grais- 
seuse Progressive, Paralysie Musculaire Progressive Atrophique ; 
Gr., Muskelatrophie, Muskellahmung. 

Definition. — A chronic wasting and degeneration of the 
muscular tissue, more especially of the muscles of the ex- 
tremities, in consequence of which there is a corresponding 
loss of motor power. 

Diagnosis. — Progressive muscular atrophy is not easily 
mistaken for any other disease, as its slow progress and suc- 
cessive implication of certain muscles and groups of muscles 
is very characteristic. There are forms of paralysis com- 
plicated with muscular atrophy, but in these cases the paraly- 
sis precedes the atrophy, while in progressive muscular atrophy 
the paresis, for it is mainly muscular weakness rather than 
paralysis, accompanies and keeps pace with the wasting of the 
muscles. 

Pathology. — The disease does not originate, as was formerly 
believed, in the muscles themselves, but in structural changes 
in the spinal cord. These changes consist chiefly in atrophic 
degenerations of the ganglion cells of the anterior horns of the 
gray matter from where the motor roots emerge which preside 
over the nutrition of the affected muscles. The muscular 
atrophy, though sometimes consisting only of simple atrophy 
without degeneration, is in the majority of cases accompanied 
by the fatty and granular forms of muscular degeneration, and 
in others by the waxy or vitreous. When the muscles of the 
face are involved, it gives rise to the affection known as labio- 
glosso-laryngeal paralysis. (For further information on this 
subject consult the author's work on Diseases of the Nervous 
System, p. 179, et seq.) 



102 NERVOUS THERAPEUTICS. 

Clinical Experience. — The remedies mostly to be relied 
upon in this disease are: Plumbum, Phosphorus, Picric ac, 
Arsenicum, Sepia, Argentum nit., Cuprum and Lachesis. The 
following have also been recommended: Physostigma, Sulphur, 
Nux vom., Belladonna and Strychnia. 

Therapeutic Indications. — These will be found under the 
heads of myelitis and posterior spinal sclerosis, which see. 

Auxiliary Treatment. — The chief dependence is on central 
galvanization, with persistent and methodical Faradization 
and galvanization of the affected muscles. 

AMYOTROPHIC LATERAL SCLEROSIS. 

Synonyms. — Inflammation of the Lateral Columns, and of 
the Anterior Tract of Gray Matter, of the Cord; Fr., Sclerose 
Laterale Amyotrophique ; Ger., Amyotrophique Lateralslitrose des 
Ruckenmarks. 

Definition. — A form of spinal sclerosis in which the lateral 
columns of the cord are symmetrically sclerosed, and the 
anterior horns of gray matter symmetrically atrophied and 
degenerated, and which, beginning in the cervical portion of 
the cord, extends to the lumbar region, and finally proves 
fatal by implicating the medulla oblongata. 

Diagnosis. — Amyotrophic lateral sclerosis differs from the 
spinal paralysis of adults, to which it bears some resemblance, 
not only by the greater intensity of its symptoms, but by the 
existence of both fibrillary twitching and spasmodic contrac- 
tions of the limbs, neither of which occurs in the latter disease. 
As for progressive muscular atrophy, of which it was formerly 
supposed to be a peculiar form, the muscular atrophy is never 
preceded by paralysis, as in amyotrophic lateral sclerosis; 
neither do spasmodic contractions occur in it, as they do in 
this disease. 

Pathology. — " I propose," says Charcot, who first separated 
this disease pathologically from progressive muscular atrophy, 
" to call that disease in which the two systems of the pyramidal 
fasciculi are affected, both in the cord and in the medulla 
oblongata, amyotropic lateral sclerosis; only the lesion cannot 



MULTIPLE SPINAL SCLEROSIS. 103 

be followed upward ordinarily beyond tbe cerebral peduncle. 
The alteration reacts on the gray substance of the anterior 
cornua of the cord and on the analogous gray parts of the 
medulla oblongata; and it follows two methods. In certain 
regions it is a destructive lesion of the cellular elements. The 
consequence is, then, an atrophy of the muscles which are in 
relation with the nerves emanating from the diseased gray 
substance. In other parts it is a simple irritative functional 
lesion of the ganglionary elements. As a result, in the parts, 
besides the paralysis more or less pronounced, there is a 
notable exaggeration of the tendinous reflexions, and even, 
at a certain moment, a considerable contracture, occasionally, 
of the members. The contracture or, in its absence, the exag- 
geration of the tendinous and muscular reflexions distin- 
guishes clinically, according to my observation, this form of 
spinal muscular atrophy from that in which the cellular 
elements are destroyed without any participation of the white 
fasciculi." 

Clinical Experience. — I am not able to give any satisfac- 
tory clinical experience pertaining to this disease, though 
what is said under this heading in regard to progressive 
muscular atrophy applies equally to this affection. 

Therapeutic Indications. — These, so far as our present 
knowledge of the disease enables us to give them, will be 
found under the head of posterior spinal sclerosis, w T hich see. 

Auxiliary Treatment. — We can add nothing of value to 
what has been said under this heading in the preceding article. 

MULTIPLE SPINAL SCLEROSIS. 

Synonyms. — Disseminated Spinal Sclerosis, Insular Spinal 
Sclerosis, Disseminated Multilocular Sclerosis; Fr., Sclerose en 
Plagues Disseminees ; Ger., Multiple Skier ose des Riickenmarks. 

Definition. — A form of spinal sclerosis characterized by the 
presence of scattered patches of sclerosed tissue in the antero- 
lateral columns of the spinal cord, but not often confined to 
them. 

Diagnosis. — When the disease is confined to the lateral 



104 NERVOUS THERAPEUTICS. 

columns of the cord there is nothing to distinguish it from 
the symmetrical form of spinal sclerosis next to be described, 
and when the posterior root-zones are implicated the symp- 
toms are similar to those of posterior spinal sclerosis or loco- 
motor ataxia; consequently it is impossible, in the present 
state of our knowledge, to diagnose the disease with certainty; 
unless the symptoms of both these conditions should happen 
to be united in the same case. 

Pathology. — The distinctive pathological feature of this 
disease is the existence of masses of sclerosed tissue, varying 
from one to two lines in thickness, distributed through dif- 
ferent portions of the cord. They are not confined to any 
particular portion of it, though they are most frequently met 
with in the lateral columns. Examined with the microscope, 
the nerve-tubes of the white and the nerve-cells of the gray 
substance are found to have disappeared, or to have greatly 
diminished in number, and to have been replaced by prolif- 
eration of the connective-tissue element, the pressure of which 
upon the nerve-cells and tubes is the cause of their disin- 
tegration and wasting, the fluid portion undergoing fatty 
degeneration. 

Clinical Experience. — Plumbum, Aluminum, Phosphorus, 
Secale and Argentum nit. are the principal remedies which have 
been given, with greater or less success, in the various forms 
of spinal sclerosis. 

Therapeutic Indications. — These will be given under the 
head of posterior spinal sclerosis, which see. , 

Auxiliary Treatment. — This is chiefly confined to preserv- 
ing, as far as possible, the general health of the patient. 
Electricity can be of but little use in these cases, though the 
primary galvanic current (constant) is said to be of some bene- 
fit in relieving the contractions. 

PRIMARY SPINAL SCLEROSIS. 

Synonyms. — Spasmodic Spinal Paralysis, Primary Lateral 
Sclerosis, Primary Symmetrical Lateral Sclerosis, Idiopathic 
Lateral Spinal Sclerosis, Paralysis Spinalis Spastica; Fr., 



PRIMARY SPINAL SCLEROSIS. 105 

Tabes Dorsal Spasm odi que ; Ger., SpatlscJie Spinalparalysie, 
Primdre Lateralsklerose des Rilckenmarks, Primare Sklerose der 
Seitenstrihige des Ruckewmarks. 

Definition. — A spasmodic spinal paralysis, caused by a sym- 
metric and systematic primary sclerosis of the lateral columns 
of the cord. 

Diagnosis. — The disease can only be recognized by the 
characteristic symptoms, viz. : paralysis with contractions, but 
without conspicuous muscular atrophy, pain in the back and 
limbs, and the absence of any intracranial lesion capable of 
accounting for the disease as a secondary disorder. Hence the 
difficulty of distinguishing between the symptoms- of this dis- 
ease and those of chronic spinal meningitis, multiple spinal 
sclerosis, and tumors pressing on the cord and giving rise to 
similar phenomena — a difficulty so great that, in the language 
of Dr. Hammond, I know of no sure sign by which, in the 
present state of our knowledge, the discrimination can be 
made. 

Pathology. — The pathological changes observed in the 
spinal cord in this disease are in perfect harmony with the 
symptoms as interpreted by what is known concerning the 
physiological action of the different parts of the cord. Thus 
Charcot has shown that proliferation and hardening of the 
neuroglia, with simultaneous wasting of the nerve- cells and 
fibres (sclerosis), occurs to a greater extent in the cervical por- 
tion of the cord than elsewhere, the sclerosed condition, when 
this part is affected, extending as far as, and even beyond, the 
outer angle of the anterior horn of gray matter, while pos- 
teriorly it almost reaches the posterior tract of gray matter. 
As we descend the cord it becomes more and more circum- 
scribed, while at the same time it approaches closer and 
closer to the cortical layer, until in the lumbar portion of the 
cord it touches the cortical layer, and at the same time only 
occupies about one-fourth the area of the lateral columns. 
When it extends to the medulla oblongata it is confined to 
the anterior pyramids, and does not involve the nuclei of the 
bulbar nerves, as in the amyotrophic form of lateral spinal 
sclerosis. 

8 



106 NERVOUS THERAPEUTICS. 

Clinical Experience. — This does not differ from that of the 
other forms of spinal sclerosis already considered. 

Therapeutic Indications. — These will be given in detail 
under the head of posterior spinal sclerosis, which see. 

Auxiliary Treatment. — See previous articles under this 
heading. 

SECONDARY SPINAL SCLEROSIS. 

Synonyms. — Secondary Spinal Degeneration ; Fr., Les De- 
generations Secondaires de la Moelle Epiniere ; Ger., Secondare Er- 
krankung Einzelner Ruckenmarksstrdnge. 

Definition. — Secondary spinal sclerosis is a lesion which 
occurs in certain regions of the spinal cord, either as a result 
of some previous disease of the cord itself or as a consequence 
of intracranial disease. 

Diagnosis. — Charcot's " foot phenomenon," AVestphal's " ten- 
don reflex," or knee phenomenon, and Onimus's " associated 
movements " are usually relied upon as diagnostic signs of 
secondary degeneration of the cord. (See the author's article 
on this subject in Arndtfs System of Medicine, Vol. II., p. 641.) 

Pathology. — The degenerative changes in this disease are 
similar to those which have already been described as charac- 
terizing the various forms of sclerosis, viz.: atrophy and 
degeneration of nervous filaments, the formation of granular 
corpuscles in the degenerated tissue, and the proliferation of the 
neuroglia. When muscular atrophy is associated with the 
paralysis and contracture resulting from the sclerosed condi- 
tion of the cord, the anterior cornua are involved in the de- 
generative process, the nerve-cells undergoing more or less 
disintegration and wasting. 

Clinical Experience. — This is similar to that of other 
forms of spinal sclerosis already described. 

Therapeutic Indications. — These will be given in full 
under the head of posterior spinal sclerosis or locomotor ataxia, 
which see. 

Auxiliary Treatment. — See above reference. 



POSTERIOR SPINAL SCLEROSIS. 107 

POSTERIOR SPINAL SCLEROSIS. 

Synonyms. — Locomotor Ataxy, Progressive Locomotor 
Ataxia. Sclerosis of the Columns of Burdach, Tabes Dorsalis; 
Fr.j Ataxic Locomotrice; Ger., Graue Degeneration der Hinter- 
strange des Rikkenmarks. 

Definition. — A form of spinal sclerosis involving the poste- 
rior root-zones of the spinal cord, characterized by loss of power 
of coordinating movements, whereby voluntary movements, 
and especially those concerned in walking, are rendered more 
or less unsteady. 

Diagnosis. — When the characteristic symptoms are present, 
such as fulgurant pains, paresthesia in the extremities, marked 
staggering on closing the eyes, the girdle sensation, the general 
lack of precision of movements, visual disturbances, etc., and, 
especially, loss of deep reflexes, the diagnosis is sufficiently 
clear; but when only tw T o or three of them are present the dis- 
ease is liable to be mistaken for mere functional disturbances 
producing ataxia. In estimating individual symptoms, we 
should remember (1) that sclerosis of the posterior columns 
always begins with sensory disturbances; (2) that the pains are 
fulgurant, intermittent and of irregular occurrence; (3) that 
they may be located in any part of the body, as the limbs, face, 
back, viscera; (4) that they precede the motor disturbances by 
months or years; (5) that they may for an indefinite period 
constitute the only symptoms of the disease; (6) that the con- 
tinuance of the first stage, previous to the appearance of the 
ataxia, is usually about three years, though often not more 
than one, and sometimes as many as five; (7) that during this 
stage the patient may enjoy excellent health, though occasion- 
ally marked, perhaps, by slight functional disturbances, ocular, 
arthritic, etc., which scarcely attract attention; at last (8) 
ataxia, with the more prominent symptoms of the second 
stage,-makes its appearance, and then, if not before, the disease 
is clearly recognized. In order to render the diagnosis more 
certain, tests may be made by means of the various reflex and 
associated movements referred to under the head of secondary 
spinal sclerosis, which see. 



108 NERVOUS THERAPEUTICS. 

Pathology. — The pathological alterations consist in a pecu- 
liar degeneration, with subsequent atrophy and hardening of 
the posterior columns of the cord and the posterior roots of the 
spinal nerves. The white substance of the cord is converted 
into a grayish softened mass. The microscope shows few 
nerve filaments, granular cells, fatty molecules and corpora 
amylacea imbedded, as it were, in a matrix of sclerosed tissue, 
the result of proliferation of the neuroglia or connective tissue 
element. The diseased cord ultimately shrinks and indurates, 
constituting real atrophy of its essential constituents. 

Clinical Experience. — The remedies which have been 
found to be of the greatest value in this disease belong mostly 
to the mineral class. They are: Plumbum. Aurum met., Aurum 
mur., Aurum cyan., Phosphorus. Argentina nit , Zincum met. and 
sulph., Alumina, Phy so stigma, Gelsemium. Belladonna, Lathyrus 
tic, jEscuIus hip., Baryta curb., Angustura, the last three, espe- 
cially, for the fulgurant pains. 

Therapeutic Indications. — Plumbum. — This remedy pro- 
duces the anatomical lesions of disseminated sclerosis, the tremor, the 
paralysis and the muscular atrophies, and it has repeatedly cured 
these symptoms. 

Aurum. — This metal and its preparations, the muriate and 
cyanate, have repeatedly cured both the fulgurating pains and the 
ataxia; weakness and paralytic feeling chiefly noticed when 
walking; amaurotic blur before the eyes. 

Alumiua. — Pain and paralysis of the lower extremities; 
impossible to walk with the eyes closed; soles of the feet feel as if 
they were swollen and too soft ; numbness of the heels when 
stepping on them; when walking he staggers and is compelled 
to sit down. 

Phosphorus. — Sexual irritation ; involuntary sexual emis- 
sions; great irritability and nervousness; paralytic feeling in 
the feet and limbs, with trembling of the knees; pains darting 
from the hip-joint ; anaesthesia, with increased heat; periodically 
returning insupportable pains in the spine, preventing walking; 
pain and tenderness in the soles of the feet. This remedy is 
suited to every stage of the complaint ; the fulgurating pains 
and visual disturbances of the first, the ataxic symptoms and 



POSTERIOR SPINAL SCLEROSIS. 109 

genital excitement of the second, and the paralytic, atrophic 
and degenerative condition of the last. 

Argentum nit. — Vertigo as if turning in a circle, preventing 
standing; momentary blindness; irregular movements of the 
extremities; limbs retracted toward the abdomen; instability 
of the limbs ; vacillating gait; cannot walk in the dark without 
staggering. I once cured a well marked case of posterior 
spinal sclerosis with this remedy after the ataxic symptoms 
had set in. 

Zincum. — Great weakness in the lumbar region and in the 
knees when walking; weakness, numbness and tremor in the 
limbs; lancinating pains extending to the knees, which feel as 
if they would give way ; paralysis of the bladder. 

Physostigma. — Feeling of unsteadiness and insecurity in 
walking; has to tread carefully, especially if the eyes are shut 
or when in the dark; feels the need of a cane or some other 
means of support ; feeling of weakness, as though paralyzed, 
passes downward through the whole length of the spine to 
the lower extremities, which feel as if asleep; staggering gait, 
as if drunk. 

Lathyrus cic. — Weakness and trembling of the limbs, followed 
by a sort of stupefaction ; almost total loss of power in the extrem- 
ities; pigs that eat it are said to drag their feet after them. 

Grelsemium. — Paralysis of all the limbs; cannot move them, 
they feel so heavy; electric-like pains through the limbs; un- 
steady gait; muscles will not obey the will; sense of helpless- 
ness from brain-weakness; temporary blindness; paralysis of 
the bladder. 

Belladonna. — Loss of power to coordinate muscular move- 
ments; when walking he raises his feet slowly and puts them 
down with force; trembling of the muscles and limbs; weak 
and tottering gait; paralytic weakness of all the muscles, 
especially of the feet; paralysis of the motor oculi; fulgurating 
pains; especially valuable during the initial period of the 
disease. 

Helleborus. — Muscles do not act in harmony unless the 
attention is fixed upon them; walk slow and tottering; twitch- 
ing, tearing pains in the limbs; sudden relaxation of certain 



110 NERVOUS THERAPEUTICS. 

muscles; he lets fall an object held in the hand; staggering 
gait, with want of firmness in the legs and bending of the 
knees; vesical tenesmus; impotence, with flaccid penis. 

^Isculus hip. — Lameness and paralytic feeling from neck 
down; back and legs weak, can hardly walk, must lie down; 
fulgurant pains; ocular and vesical tabetic symptoms. This 
remedy is indicated even when the sclerosis is well advanced. 

Ignatia. — Weakness and trembling in the limbs ; he was 
unable to walk, but was obliged to remain sitting, because 
when walking the knee was involuntarily drawn upward. 

Baryta carb. — When standing he felt a blow in the thigh, 
above the right knee, so violent that he believed he would 
fall forward; in the right knee a rapid momentary pain, like 
cutting with a knife, which makes the leg lame; trembling of 
the hands and limbs; great mental and bodily weakness; 
constant inclination to lie down. 

Angustura. — Twitching and jerking along the back like 
electric shocks; paralytic weakness of the whole body; in- 
dicated in the spasmodic form, or when the paresis is associated 
with fulgurant pains. 

Silicea. — Trembling in the limbs, as if he had lost all power 
over them ; wandering pains, passing quickly from one part 
of the body to another; sense of great debility, wants to lie 
down; limbs sore, lame and cold, go to sleep easily; paralytic 
weakness in the joints when sitting or walking ; drawing, 
jerking pain in the hip-joint; tearing pains in the thighs, 
followed by numbness. 

Oxalic ac. — Pains shooting down from the spinal cord to 
the limbs, especially the lower ones; back feels too weak to 
support the body; dyspnoea, followed by general numbness; 
jerking pains, confined to small spots and lasting only a 
moment. 

Nux vom. — Staggering walk; when he walks he drags his 
feet; numbness and deadness of the legs and feet; incomplete 
paralysis, with the power of motion not entirely gone; 
paralysis of the bladder: obstinate constipation. 

Auxiliary Treatment. — The operation of nerve- stretching 
has, until very recently, been regarded as an efficient means of 



POSTERIOR SPINAL SCLEROSIS. Ill 

relieving the most distressing symptoms of locomotor ataxia, 
but at present the consensus of opinion on the subject among 
those whose opportunities of forming a correct estimate of its 
value in this disease are the greatest, is, that it is doubtful 
whether any marked symptoms have been permanently re- 
lieved by it. 

Karl Pauli highly recommends the lukewarm baths introduced 
by Westphal as the best way of relieving the fulgurating pains, 
employing them almost constantly for weeks, or until the pains 
subside. 

Both Mochoukowsky and Charcot speak very highly of the 
treatment by suspension. The former, who was the originator 
of the treatment, makes use of the apparatus of Dr. Sayre, of 
Xew York, the suspension at first being of only half a minute 
duration; this is gradually increased to three minutes, the 
maximum not exceeding four minutes. Treatment every 
other day suffices, no benefit accruing from its daily practice. 
Charcot finds that after twenty or thirty treatments Romberg's 
symptom disappears, followed by amelioration of the urinary 
and vesical symptoms; in a number of cases the plantar anaes- 
thesia passed off. Other experiments, however, have been less 
successful with this mode of treatment, one case resulting, after 
two suspensions, in spasmodic paraplegia, which disappeared 
again after three days. 

After all, however, we find that the most efficient agent in 
ameliorating the symptoms during the initial stage is electricity. 
Usually the positive pole of the galvanic current is placed on 
the nape of the neck and the negative sponge swept up and 
down the spine and limbs. Of late, Rumpf 's treatment with 
the electric brush — the rapidly interrupted Faradaic current 
— along the back and legs, has seemed to do the most good, and 
almost entirely superseded every other form. The anode is 
applied to the sternum, and the cathode energetically carried 
over the spine and extremities until the surface turns to a deep 
red, each seance lasting ten minutes. 



112 NERVOUS THERAPEUTICS. 

SPINAL TUMORS AND OTHER ABNORMAL GROWTHS. 

Synonyms. — Meningeal and Intramedullary Spinal Tu- 
mors ; Fr. , Tumeurs Rachidiennes, Tumeurs de la Moelle Epiniere ; 
Ger., Krankhafte Geschwulste des Rilckenmarks. 

Definition. — Tumors, foreign growths and adventitious 
products within the spinal canal. 

Diagnosis. — The diagnosis is necessarily more or less un- 
certain, since the same symptoms may be produced by very 
different causes. Most cases, however, are attended by one or 
more of the following characteristics : (1) a very gradual onset 
of the symptoms ; (2) exacerbations and remissions correspond- 
ing to changes in the size and vascularity of the tumor or 
other growth ; (3) symptoms depending on the seat and cir- 
cumscribed character of the lesion; and (4) the presence or 
absence of air^ other disease of the part capable of producing 
the symptoms. The nature of the foreign growth is, as a rule, 
still more difficult to determine. When the patient exhibits 
unmistakable signs of a scrofulous, syphilitic or cancerous 
dyscrasia, the presumption will be in favor of its belonging to 
the prevailing diathesis. Some light may also be thrown upon 
the subject by the presence of tumors elsewhere. 

Clinical Experience. — This does not differ materially from 
the clinical experience given under the head of cerebral tumors, 
which see. 

Therapeutic Indications. — These will be found under spi- 
nal meningitis, myelitis, acute ascending paralysis and other forms 
of paraplegia, which see. 

Auxiliary Treatment. — In cases of debility, and especially 
when of a scrofulous, syphilitic or cancerous nature, the vital 
power should be raised, the nutritive functions improved, and 
the patient kept under the most favorable l^gienic conditions. 

SPINAL CONCUSSION. 

Synonyms. — Concussion of the Spinal Cord, Commotio 
Medulla Spinalis; Fr., Commotion Spinale, Commotion de la 
Moelle Epiniere; Ger., Erschutterung des Rilckenmarks. 



SPINAL CONCUSSION. lid 

Definition. — A shock communicated to the spinal cord and 
interfering with its functions. 

Diagnosis. — In the absence of definite paralysis it is often 
necessary, in order to ascertain whether any organic lesion has 
taken place, to wait until sufficient time has elapsed after the 
accident to determine that question. This is the more neces- 
sary because meningitis, myelitis and anaemia of the cord 
are liable, sooner or later, to result from spinal concussion. 
These results, when present, will of course manifest themselves 
by their characteristic symptoms ; but it should be remem- 
bered that several weeks may elapse after the injury before 
spinal symptoms are developed. Moreover, the difficulty of 
forming a correct estimate of the nature and extent of the 
spinal injury is greatly enhanced, in many cases, by the dis- 
position of the patient and his friends — we refer especially to 
railroad accidents — to exaggerate the symptoms, either in 
consequence of their excited imagination or from interested 
motives, the question of pecuniary damage being in many 
instances an important factor in the diagnosis. The physi- 
cian owes it to himself, no less than to others, to exercise the 
utmost care and intelligence in coming to a correct conclusion 
in such cases. 

Pathology. — On this subject Erichsen, the leading writer 
on concussion of the spine, says: "We should be taking a 
very limited view of the pathology of concussion of the spine 
if we were to refer all the symptoms, primary and remote, to 
inflammatory conditions, either of the vertebral column, the 
sheaths of the spinal nerves, the meninges of the cord, or the 
substance of the medulla itself. Important and marked as may 
be the symptoms that are referable to such lesions as these, 
there are undoubtedly states, both local and constitutional, 
that are primarily dependent on molecular changes in the 
cord itself, or on spinal anaemia induced by the shock of the 
accident either directly on the cord itself, or indirectly, and 
at a later date through the medium of the sympathetic, in 
consequence of which the blood distribution to the cord be- 
comes disturbed and diminished." 

Clinical Experience. — Calendula, Hypericum, Arnica, Rhus 



114 NERVOUS THERAPEUTICS. 

tax., Conium, Cicuta, Sulphuric ac. and Hepar sidph 
the leading remedies resorted to in this condition, the first 
three being prescribed immediately after the accident, both 
internally and locally. 

Therapeutic Indications. — These will mostly be found 
under spina! hypertemia. anaemia, haemorrhage, myelitis, menin- 
gitis, paralysis and sclerosis, which see. We shall here confine 
ourselves to those above mentioned. 

Hypericum. — Great nervous depression following spinal con- 
cussion : vertebrae very sensitive to the touch ; inability to 
walk after the injury, especially when the attempt is accompa- 
nied, by violent pains : retention of urine, with shuddering 
and desire to urinate. 

Calendula. — Traumatic cases, with stinging pains at the seat 
of injury: the patient is very uneasy in every position ; 
great tendency to start, especially on hearing a noise ; the in- 
jured part becomes red and inflamed; shuddering in the back; 
frequent micturition. 

Arnica. — Spinal concussion attended by intrarachidian 
haemorrhage ; limbs cold, pulse slow and weak, and sickness 
of the stomach : paresis, with or without numbness of the 
limbs ; pain aggravated by movement : symptoms better by 
lying quiet. 

Rhus tox. — Paralysis, following spinal concussion ; extreme 
coldness of the hands and feet : muscular startings and 
twitchings ; pains and numbness in the paralyzed limbs. 

Cicuta. — Paralysis, with insensibility: convulsive twitchings 
of the muscles ; coldness of the body, with an excited and 
apprehensive state of the mind; irritability of the bladder; 
constipation. 

Sulph. ac. — Weakness in the back and lower extremities so 
great as to prevent standing without support ; shooting pains 
in the limbs, with trembling of the whole body ; violent press- 
ure on the neck of the bladder, with retention of urine. 

Conium. — Spinal concussion attended by a sensation of 
numbness in the paralyzed parts ; sensation in the limbs as if 
they were surrounded by tight bands. 

Hepar sulph. — Great weakness of the limbs, with nervous 



SPINAL CONCUSSION. 115 

depression ; shiverings from below upward ; very excited 
and irritable; nervous trembling; weakness of the bladder, 
with involuntary discharges of urine. 

Auxiliary Treatment. — If reactive fever sets in, accompa- 
nied by much pain in the back, ice or ice-water should be 
applied to the spine, for which purpose Chapman's rubber- 
bags will be found convenient. If necessary, the temperature 
of the body, and especially of the extremities, should be raised 
and maintained at the normal standard by artificial means. 
The continuous galvanic current will be found beneficial in 
hypersesthetic states of the spinal cord. Cold salt-water douches 
and the shower-bath will sometimes prove useful in advanced 
cases. In most cases perfect rest in the recumbent position 
will be required for some time after the accident. Unless the 
shock is a very severe one, these measures, with rest and sleep, 
plenty of fresh air and a simple, nutritious diet, will be suffi- 
cient in most cases to restore the patient to health ; but care 
must be taken not to permit any exercise until after the nerv- 
ous system has recovered from its enfeebled and exhausted 
state ; then the patient will often be benefited by a change of 
air and scene. 



PART III. 
CEREBRO-SPINAL DISEASES. 



CEREBROSPINAL HYPEREMIA. 

Synonyms. — Cerebrospinal Congestion ; Fr., Congestion 
Cerebro-spinale, Hyper emie Cerebro-spinale ; Ger., Cerebro-spinale 
Hyperamie. 

Definition. — A simultaneous excess of blood in any portion 
of both the cerebral and spinal tissues. 

Diagnosis. — Cerebro-spinal congestion is not usually recog- 
nized as a distinct affection, partly because it is partial rather 
than general, and partly because it is most frequently a symp- 
tom of some other disease. Those cases usually regarded as 
belonging to the convulsive form of cerebral congestion, but 
unattended by loss of consciousness, are of this character. 
The characteristic symptom is stiffness and aching in the back 
part of the head and neck, which may subsequently develop 
into epileptiform convulsions, or into a tonic contraction of 
the extensor muscles of the spine. 

Pathology. — The congestion is usually limited to the base 
of the brain and upper portion of the spinal cord. The con- 
vulsive action is due to implication of the medulla oblongata, 
and when the cerebral hemispheres are involved there is also, 
in most cases, loss of consciousness. 

Clinical Experience. — Gelsemium and Cimicifuga are the 
two leading remedies in this disease, and are almost infallible. 
Belladonna, Nalrum brom., Kali brom. and Passiflora incar. are 
also useful remedies, especially the last. 

Therapeutic Indications. — These are given under the 
heads of cerebral and spinal hypersemia, which see. 

(116) 



NEURASTHKNIA. 



117 



NEURASTHENIA. 

Synonyms. — Nervous Exhaustion, Xervous Debility, Brain 
Fag, Cerebro-spinal Anaemia, Cerebrasthenia et Myelasthenia; 
Fr. } Anemie Cerebro-spinale ; Ger., Cerebro-spinale Anamie. 

Definition. — A functional disease affecting the whole nerv- 
ous system, both cerebro-spinal and sympathetic, and marked 
not only by great mental and physical debility, but by other 
well-defined, but constantly varying symptoms, which appear 
and disappear suddenly without any regular order of suc- 
cession. 

Diagnosis. — The disease is liable to be confounded with 
anaemia and hysteria. The following tables, prepared by 
Dr. Beard, give the differential diagnoses between them : 



Neurasthenia. 



General Anaemia. 



Chiefly found in nervous diathesis. 

Impoverishment of nervous system ; no 

necessary anaemia. Patient may be 

plethoric. 
Found chiefly between the age of fifteen 

and sixty. 
Not at all necessarily dependent on any 

important recognizable organic dis- 



Pulse may be full or normal, but some- 
times very rapid or very slow. 
Xo cardiac murmurs. 



No pallor, sometimes even a rubicund 
appearance. 

Easily fatigued by exertion ; mental 
labor in cerebrasthenia more ex- 
hausting than physical. Memory 
often temporarily weakened, and 
consecutive thought and sustained 
mental activity frequently impos- 
sible, even when prolonged muscu- 
lar labor causes little or no fatigue. 



Appears also in the tuberculous, or 
rheumatic, or other diathesis. 

Impoverishment of the blood; increase 
of water and diminution of the red 
corpuscles. 

Found in all periods of life, from ex- 
treme infancy to old age. 

More frequently, though not necessa- 
rily, associated with some organic 
disease, as tuberculosis, carcinoma, 
Bright' s disease, etc. 

Pulse small, weak and compressible. 

Murmur at the base of the heart and 
over the large arteries, as the ca- 
rotid, subclavian, etc. 

Very perceptible pallor of the face, 
especially of the lips. 

Easily fatigued by exertion ; physical 
labor always more exhausting than 
mental. 



118 



NERVOUS THERAPEUTICS. 



Neurasthenia. 


General Anaemia. 


Insomnia a very frequent complication. 

No necessary or constant disturbance of 

the circulation. 
Habitual mental depression. 
Though common to both sexes, not so 

relatively frequent in females. 
Usually recovers, but gradually, under 

the influence of rest and nutritious 

food. 


Insomnia not so frequent a complica- 
tion ; frequently an abnormal ten- 
dency to sleep by day as well as by 
night. 

Disturbance of the circulation, with 
habitually cold extremities. 

Mental depression not so frequent. 

Far more frequent in females. 

May be rapidly removed by the removal 
of the organic cause. 


Neurasthenia, 


Hysteria. 


No convulsions or paroxysms. 

No globus hystericus, no anaesthesia of 
the epiglottis, ovarian tenderness 
less common, and attacks of anaes- 
thesia far less frequent and less 
permanent. 

Symptoms more moderate, quiet, sub- 
dued and passive. 

May occur in well-balanced, intellect- 
ual organizations. 

Very common in males, though more 
common in females. 

Is always associated with physical de- 
bility. 

Never recovers suddenly, but always 
gradually, and under the combined 
influences of hygiene and objective 
treatment. 


Hysterical convulsions and paroxysms. 

Globus hystericus, anaesthesia of the 
epiglottis, ovarian tenderness and 
attacks of general or local anaes- 
thesia. 

Symptoms acute, intense, violent and 
positive. 

Usually associated with great emotional 
activity and unbalanced mental or- 
ganization. 

Very rare in males. 

In the mental or psychical form, occurs 
in those in perfect health. 

May recover suddenly and under purely 
emotional treatment. 



Pathology. — General neurasthenia was formerly, and by- 
many still is, regarded pathologically as a form of cerebro- 
spinal anaemia. Its resemblance to spinal irritation, which is 
generally regarded as a form of spinal anaemia, is most strik- 
ing. The functional disturbances are not only equally great 
and varied, but even the characteristic spinal tendency is 
sometimes present. I am, therefore, disposed to regard the 



NEURASTHENIA. 119 

disease as consisting essentially in a fluctuating local or partial 
anaemia of the great nerve-centres, in which the quantity and 
not, as in general anaemia, the quality of the blood circulating 
in the part is at fault. 

Clinical Experience. — The favorite remedies for this dis- 
ease appear to be; Phosphorus, Chininum sulph., Strychnia, Phos- 
phoric ac, Erythroxylon coca, Nux vom., Picric ac, Zincum brom., 
Zuicum pic. and Avena sat. Many other remedies, however, 
have been employed with benefit in different cases ; indeed, 
almost every remedy in the materia medica may be called 
for at one time or another, so variable and peculiar are the 
symptoms. 

Therapeutic Indications. — Phosphorus. — Great heaviness 
and weariness from the least exertion; extreme mental and 
physical prostration; bruised feeling in the back and limbs; 
myelasthenia. 

Chininum sulph. — Neurasthenia following severe and exhaust- 
ing illness, loss of vital fluids, or overexertion, either bodily or 
mental; nervous trembling; weakness and trembling of the 
lower limbs; coldness of the extremities. 

Erythroxylon. — General nervous debility, the slightest exer- 
tion being attended by fatigue; mental depression, with 
anxiety and palpitation of the heart; oppression of breathing 
arising from nervous debility; sleeplessness and disinclination 
to work or move' about; constipation, with abdominal disten- 
sion; fainting spells from nervous weakness; coldness of the 
limbs. 

Arsenicum. — Constant disposition to lie down; sensation of 
weakness in the small of the back ; weakness of the lower limbs, 
preceded or accompanied by copious watery stools; trembling 
of the limbs from debility; thirst for small quantities of water; 
sleeplessness and restlessness, especially at night. 

Calcarea phos. — Nervous prostration, with great depression of 
spirits; sore, bruised feeling in the back, with inclination to 
lie upon it; coldness and weakness of the lower limbs from 
defective circulation in them. 

Strychnia phos. — Aching pain, sometimes burning, extending 
from the back to the front of the chest, causing a feeling of 



120 NERVOUS THERAPEUTICS. 

nausea and anxiety; tenderness on pressure over the dorsal 
region; sleeplessness; cold feet, covered with clammy perspira- 
tion ; great weakness of the lower limbs from exhaustion of the spinal 
motor nerve-cells ; myelasthenia. 

Avena sat. — Neurasthenia of business and professional men, 
teachers, and women who have become exhausted by household 
cares and worry; coldness of different parts of the body de- 
pending on weakness of the circulation from lack of nerve 
force; cerebrasthenia. 

Nux vom. — Nervous debility arising from debauchery and 
dissipation, late hours, high-seasoned food and abuse of ardent 
spirits; mental exhaustion of students and professional men; 
insomnia produced by overwork, business cares, etc. Indi- 
cated in all cases wdiere there are a disordered stomach and 
constipation. 

Zincum. — Chronic cases, attended by great mental and bodily 
depression; headache produced by mental exertion; loss of 
memory; cold extremities, with paralytic weakness ; frightful 
dreams. 

Staphisagria. — Nervous exhaustion caused by excessive sexual 
indulgence, onanism or loss of vital fluids; great mental de- 
pression; nocturnal emissions followed by great prostration; 
headache, backache and loss of memory, with inability to per- 
form either mental or physical labor. 

Epiphegus. — Nausea and general languor; severe pain in the 
forehead caused by any unusual demand upon the system; 
aggravated by rising and going about, always better by rest in 
a supine position and by sleep. 

Zincum brom. — Cerebrasthenia caused by anaemia; mental and 
bodily weakness, with tendency to paralysis of the lower ex- 
tremities. This remedy is preferable to Zinc alone, as it has a 
quicker action and is more readily absorbed. 

Picric ac. — Hale regards this as one of our best restoratives of 
a wasted and worn-out nervous system; the least mental or 
physical effort exhausts the patient and brings on headache; 
homoeopathic to the brain-fag of students, school-girls and 
literary or business men and women. 

Zincum pier. — Cerebrasthenia and nervous exhaustion from 



NEURASTHENIA. 121 

overworked brain or from sexual excesses; profound neuras- 
thenia, when the nervous exhaustion has passed beyond the 
stage of erethism, seminal emissions or erotomania, 

Calcis hypophos. — Neurasthenia attended by profuse night- 
sweats; sleeplessness, depression of spirits, loss of appetite, 
emaciation; pale and haggard look; habitual coldness and 
venus congestion of the limbs from debility; loss of virile 
power. 

Ignatia. — Oppression of the chest and breathing from weak- 
ness; weakness of memory; depression of spirits; disposed to 
weep from the most trifling causes; loss of appetite, with feel- 
ing of repletion after swallowing a mouthful or two ; palpita- 
tion of the heart on rising in the morning or after eating; 
complete absence of the sexual desire ; face wan and pale ; 
sleepless and full of fanciful apprehensions. 

Phosphoric ac. — General debility, with feeling of extreme 
weakness and prostration; cold sweats during the day or on 
making any physical exertion; loss of all virile power; profuse 
night-sweats, followed by chilliness; mentally as well as 
physically depressed. 

Zincum phos. — According to Hammond, who first introduced 
the remedy, it is homoeopathic to mental depression, debility 
and nervous weakness, since in large doses it removes these 
symptoms when caused by cerebral congestion. Small doses, 
on the other hand, have in our experience frequently relieved 
these symptoms when dependent on cerebral ansemia. 

Physostigma. — Irritable spine, nervous headache and mental ex- 
haustion; eyes feel weak and swollen; smarting, sore feeling on 
the tip of the tongue which feels as if scalded ; aversion to cold 
water ; mental exertion tends to produce nausea. 

Consult, also, spinal ansemia and spincd irritation. 

Auxiliary Treatment. — One of my city patients who was 
gradually recovering from a severe attack of neurasthenia, 
attended w r ith aphonia, was induced during the recent Brown- 
Sequard craze, to submit to repeated hypodermic injections of 
his so-called "vitalizing fluid." At first the patient seemed to 
be benefited, as he speedily recovered his voice, but reaction 
setting in he again lost it, and his subsequent recovery was 
9 



122 NERVOUS THERAPEUTICS. 

manifestly greatly retarded by the absurd " scientific treat- 
ment" to which he had been thus subjected. This remedy (!), 
which at best is nothing more than a mechanical stimulant, 
is liable to give rise to septic poisoning or tubercular infec- 
tion, and ought never to be sanctioned in these cases even as 
an auxiliary proceeding. 

As a general rule, patients suffering with this disease will 
soonest recover by following closely what is known as the 
Weir Mitchell method of treatment. This consists (1) in per- 
fect rest, both mental and physical; (2) the acceleration of 
muscular waste, and the consequent ability of assimilating a 
greater amount of food, by massage of the muscles by a 
trained shampooer, and by muscular contraction produced by 
Faradization ; and (3) b}*- supplying the waste so produced by 
regular and high feeding, so that the whole system, and the 
nervous system in particular, shall be abundantly nourished. 
The diet is to be increased and strengthened from day to day 
as this process goes on, until at last the patient is able to 
take, "in addition to two quarts of milk daily, three full 
meals, viz. : breakfast, consisting of a plate of porridge and 
cream, fish or bacon, toast and tea, coffee and cocoa ; a luncheon 
at 1 p.m. of fish, cutlets or joints, stewed fruit or cream, or 
a pudding; dinner at 7 p.m., consisting of soup, fish, joint 
and sweets; and, in addition, a cup of raw meat soup at 
7 a.m. and 11 p.m. Should there be an occasional attack 
of dyspepsia, which rarely happens, it is at once relieved 
by keeping the patient on milk alone for twenty-four hours. 
The raw meat soup is made as follows : Take one pound of raw 
fillet of beef, chop it finely and place it in a bottle with a pint 
of water and five drops of hydrochloric acicl. Stand the mix- 
ture in ice all night, and in the morning set the bottle in a 
pan of water at 110° F., and keep it two hours at this tempera- 
ture. It is then to be thrown on a stout cloth, and strained 
until the remaining mass is nearly dry. The filtered liquid is 
given in two or three doses in the course of twenty-four hours." 
To give the soup the flavor of cooked meat, the beef to be 
used may be quickly roasted on one side, and then the process 
completed as above described. 



CEREBROSPINAL MENINGITIS. 123 



CEREBRO-SPINAL MENINGITIS. 



Synonyms. — Epidemic Meningitis, Cerebrospinal Fever, 
Spotted Fever, Epidemic Cerebro-spinal Meningitis; Fr., Men- 
ingite Ccnbro-spinale Epidemique Meningite Cerebro-rachidienne ; 
Ger., Cerebral- Typhus, Epidemische- Meningite, Genickkrampf, Ge- 
nickstarre. 

Definition. — An acute epidemic febrile disease, depending 
on a diffusive inflammation of the pia mater of the brain and 
spinal cord, and characterized by sudden invasion, with ex- 
treme nervous shock, followed by vomiting, fever, violent 
headache, extreme prostration, great restlessness, excessive 
pain referred to the back of the head and spine, spasmodic 
contraction of the spinal extensor muscles, excessive cutaneous 
sensibility and frequent delirium, and accompanied by pur- 
puric and other eruptions on the face and limbs. 

Diagnosis. — The disease is liable to be mistaken for typhus 
fever, purpura hsemorrhagica and malignant scarlatina. 
From the first it may generally be distinguished by the sudden 
appearance of the rash, without any previous mottling of the 
skin, and by the nervous symptoms above noted ; from pur- 
pura hEemorrhagica, by the intensity of the fever and the 
peculiar nervous symptoms ; and from malignant scarlatina, 
by the characteristic rash, sore throat and other symptoms of 
that disease. 

Pathology. — The inflammation of the pia results in an 
exudation of purulent matter, which is deposited both at the 
base and on the convexity of the brain, in its various depres- 
sions, and along the course of its great vessels, on the pons 
varolii and cerebellum, and on the posterior surface of the 
spinal cord, especially in the lumbar region. The cerebral 
membranes are all more or less injected; and the arachnoid is 
rendered opaque by the puruloid exudations before men- 
tioned, which vary in consistence from a thin milklike lymph 
to thick and dense fibrino-purulent deposits. The brain sub- 
stance itself is more or less injected, and sometimes small spots 
of secondary softening occur, but in other respects the organ 
usually presents a normal appearance. The disease, therefore, 



124 NERVOUS THERAPEUTICS. 

is a cerebrospinal meningitis, of a specific, infective character, 
originating probably in a disease-germ, the nature of which is 
at present unknown. 

Clinical Experience. — The remedies of greatest clinical 
reputation in this disease are Gelsemium and Cimicifuga. 
Aconite, Veratrum vir., Belladonna, Opium and Digitalis are also 
frequently prescribed. Baptisia, Rhus tox., Apis, Hyoscyamus, 
Stramonium, Bryonia. Nux vom., Arsenicum, Arum tri., Kali 
brom., Amm. brom., Cicuta, Agaricus, Cannabis ind., Cuprum 
acet., Lachesis, Crotalus, Lachnanthes and Cactus have all been 
used with more or less benefit in particular cases. 

Therapeutic Indications. — Gelsemium. — Intense cerebro- 
spinal congestion, preceded by a severe chill; nausea and 
vomiting, followed by great depression, with dulness of speech, 
livid cheeks, dilated pupils, icy coldness of hands and feet, 
extreme prostration, very weak pulse and laborious breathing; 
general muscular weakness, without any impairment of the 
mental power; somnolency and coma: sweating relieves. 

Cimicifuga. — Pain in the neck, shoulders and spine, also in 
the head, but not very violent, except perhaps in the top and 
back; low, restless, excitable delirium, like that of delirium tremens; 
eyes painful and sensitive to pressure ; pupils dilated : general 
prostration, accompanied with more or less vomiting; tongue 
swollen and throat dry, causing a constant desire to swallow; 
muscular twitchings in various parts of the body ; profuse 
cold sweat and very quick pulse. 

Veratrum vir. — Severe pain in the neck and shoulders; 
vertigo, with dimness of sight, dilated pupils and vomiting ; 
loss of consciousness, with coldness of the body, irregular and 
feeble pulse and great prostration ; convulsive twitchings : 
tonic contraction of the extensor muscles of the spine ; pulse 
frequent and feeble ; trembling of the whole body. 

Opium. — Somnolency, or a tendency to stupor, with or with- 
out delirium; face bloated and muscles relaxed; head and 
limbs feel cold, numb and heavy ; eyes fixed and half closed ; 
opisthotonos, with constrictive feeling in the chest and diffi- 
culty of breathing ; vomiting, colic, diarrhoea or constipation ; 
abdomen hard and swollen ; spasmodic jerkings of the limbs ; 
cold perspiration; coma; worse when sweating. 



CEREBROSPINAL MENINGITIS. 125 

Digitalis. — Stiffness in the back and side of the neck; sharp 
stitches and severe cutting pains in the nape of the neck; 
heart's action slow, irregular and labored; head tends to fall 
backward when raised up or sitting; violent lancinating pains 
in the head, especially in the occiput; delirium resembling 
that of delirium tremens (Cimicifuga) ; depression accom- 
panied by faintness and vomiting; convulsions, with retrac- 
tion of the head ; syncope, with coldness and tendency to 
collapse. 

Aconite. — In cases where there is w T ell-marked reactionary 
fever, attended by chilliness, thirst, restlessness, dryness of the 
skin and anxiety of mind. 

Baptisia. — Typhoid symptoms, accompanied by a bruised and 
painful feeling in the back of the head and neck ; body feels 
stiff and sore all over ; dark, livid spots on the skin ; great rest- 
lessness, especially of the head and limbs, which are in con- 
stant motion; stomach sore and sensitive to pressure; vertigo; 
weakness and trembling of the limbs. 

Apis mel. — Pain and stiffness in the back of the neck ; 
burning and throbbing in the head; stabbing pains in the 
occiput : great mental and bodily prostration, with sense of 
suffocation ; swelling of the face, giving it an cedematous ap- 
pearance ; hyperesthesia of the skin, with stinging pains all 
over the surface; great oppression of breathing, feels as though he 
would suffocate; pulse variable and intermitting; dimness of 
sight ; urine scanty or suppressed. 

Cicuta. — Vertigo, with moaning delirium ; head retracted ; 
muscles of the neck sore and stiff; anxious expression of 
countenance ; dilated pupils ; double vision ; tonic contraction 
of the spinal extensor muscles, especially those of the neck; 
opisthotonos; spasmodic action of the muscles of the face and 
limbs; convulsions attended with cries, working of the jaws, 
distortion of the limbs, spasm of the muscles of the chest, 
painful distension of the abdomen, followed by insensibility 
and immobility; pain in the stomach and vomiting; ashy 
hue of the skin ; diarrhoea or constipation ; general pa- 
ralysis. 

Hyoscyamus. — Drawing pain in the neck when turning the 



126 NERVOUS THERAPEUTICS. 

head ; violent headache, alternating with pains in the back of 
the neck; throbbing sensation in the brain; heaviness of the 
head, with dimness of vision, palsy of the tongue, and small, 
quick and intermitting pulse; stiffness of cervical muscles and 
trismus ; spasms of the chest, with temporary arrest of breath- 
ing; epileptiform convulsions; jerking of the limbs; constant 
grinding of the teeth; brown spots, large pustules and gangre- 
nous vesicles on the skin ; relaxation of the lower sphincters, 
with involuntary evacuations. 

Cannabis ind. — Pain in the back of the head and across the 
shoulders and spine; fixed, staring eyes, with dilated pupils; 
vertigo on rising; hearing unusually acute; emprosthotonos or 
opisthotonos, with loss of consciousness; face cold, with drowsy 
and stupid expression of countenance; great oppression of the 
chest; pulse feeble and irregular; collapse, with pale, clammy 
and insensible skin. 

Hydrocyanic ac. — Malignant cases, attended with immediate 
collapse; protruded half-open eyes; dilated and insensible 
pupils; bloated and bluish face; eyes insensible to light; 
tongue protruded and paralyzed; feeble, irregular pulse and 
respiration ; general coldness ; involuntary evacuations of faeces 
and urine. 

Veratrnm alb. — Stiffness of the neck, with bursting sensation 
in the head and choking in the throat; violent headache, 
with delirium ; vomiting, with convulsive shocks in the head 
as soon as it is raised up ; head thrown back and rolling from 
side to side ; face pale, cold and cadaverous looking ; convul- 
sions, with loss of sense and motion; watery diarrhoea, attended 
by collapse; coldness and numbness of the limbs. 

Phosphorus. — Headache, with burning and stinging pains in 
the occiput; laming pains in the spine; dulness of hearing; 
frequent fainting; great prostration; petechial and purpuric 
eruptions on the surface of the limbs or body; tingling and tearing 
pains in the limbs; difficulty of breathing. 

Nux vom. — Hyperaesthetic condition of the cerebro-spinal 
system of nerves; shocks in the brain; scalp sensitive to the 
touch; loud, reverberating sounds in the ears; oversensitive- 
ness to odors; stitching pains through the body; convulsions 



CEREBROSPINAL MENINGITIS. 127 

renewed by the least touch; conscious opisthotonos; bruised 
sensation in the head, body and limbs, with feeling of heavi- 
ness; numbness and paralytic drawing in the extremities. 

Cro talus. — Nausea and vomiting, preceded or accompanied 
by faintness; extremely violent headache; burning, un- 
quenchable thirst; delirium, with staring eyes; anxious breath- 
ing; purplish spots on the skin; feeble pulse; pallid face; 
painful heaviness of the limbs. 

Argentum nit. — Cutting pains extending through the head 
from forehead to occiput, increasing and diminishing frequently; 
vertigo, photophobia, ringing in the ears, double vision; 
tongue coated white, or else black, hard and dry ; sordes upon 
the teeth; lips and nails blue; breathing greatly oppressed; 
epileptiform convulsions; jerking and trembling of the limbs; 
face pale and emaciated; clouds before the eyes; deafness; in- 
continence of faeces and urine. 

Cocculus. — Headache, with vertigo, vomiting and feeling as 
if the eyes would be torn out ; painful stiffness of the muscles 
of the neck; epileptiform convulsions; face pale and bloated; 
convulsive trembling of the head ; miliary eruptions ; fainting 
fits; constriction of the chest, with heavy and laborious 
breathing. 

Rhus tox. — Heavy, bruised feeling in the brain, extending 
to the ears and back of the neck ; bruised feeling in the back 
and limbs; vesicular eruptions on the face and upper part of 
the body; vertigo, bleeding of the nose and somnolency; dry 
cough, with perhaps bloody sputa; great restlessness, with 
intense aching in the limbs. 

Cuprum. — Nausea and vomiting from cerebral congestion; 
nervous trembling, with hyperesthesia of the senses; con- 
vulsions; sad, depressed features, with dim, sunken eyes, 
surrounded with blue rings; general paralysis; somnolency 
or coma. 

Belladonna. — Stupefying headache, worse in the back of the 
head and extending to the neck ; pain in the neck ameliorated 
by bending the head backward ; hyperesthesia of the special 
senses; convulsive movements, especially of the muscles of 
the face and neck ; grinding of the teeth ; upper part of the 



128 NERVOUS THERAPEUTICS. 

body hot, extremities cold; pupils dilated; delirium with or 
without coma; retention or inconstancy of urine. 

Plumbum. — Early paralytic symptoms ; limbs feel too heavy 
to be moved ; heavy feeling in the back of the head ; retraction 
of the abdomen; colic, with obstinate constipation; emaciation ; 
somnolency. 

Lyeopodium. — Headache, with pain extending down the neck; 
hyperesthesia of the special senses; dyspnoea, ivith fanlike 
movement of the nostrils; sense of constriction in the chest and 
abdomen, as though bound with a hoop; numbness and 
twitching of the limbs; dreads solitude; melancholy and 
irritable. 

iEthusa cynap. — During dentition, when accompanied by 
sudden, excessive, almost continuous vomiting, and attended 
by epileptiform convulsions ; face pale, eyes staring, pupils 
dilated and insensible to light. 

Arsenicum. — Stiff, sore feeling in the back of the neck ; scalp 
sensitive and painful; the characteristic thirst for but little 
water frequently repeated ; tetanic rigidity; spasmodic grind- 
ing of the teeth; great restlessness and prostration; vertigo; 
dulness of vision; anxious respiration; tongue dry and trem- 
bling; face pale and corpselike; diarrhoea; somnolency. 

Cantharides. — Lancinating pains in the occiput, extending 
deep into the head; spasmodic constriction of the throat; 
priapism, with amorous frenzy; tetanic spasms; eyes staring; 
face pale, with terror-stricken expression; general coldness, 
faintness and trembling. 

Agaricus. — Drawing pains in the back of the head; stiffness 
and soreness of the nape of the neck and spine ; violent pains 
all along the spine; delirium; somnolency. 

Zincum. — Convalescence retarded; prostration of the vital 
power, with profuse and easy sweating; flushes of heat in head 
and face ; trembling and twitching of the hands and feet; 
weak and watery eyes; weak memory; troubled with flatulent 
colic; priapism; dysuria; constipation. 

Auxiliary Treatment. — Local measures are usually of 
little avail. Ice to the head and spine sometimes has the 
effect of allaying the pain, but there is no evidence of its ever 



INFANTILE CONVULSIONS. 129 

having done any permanent good. The same is true of heat, 
except so far as its moderate use during the collapsed state 
may help to restore the normal temperature. Stimulants, 
carefully administered, may also serve to help bridge over a 
dangerous crisis in the disease, but their use under any circum- 
stances in this disease is of very doubtful propriety. The 
diet during the earlier stage, or while the patient's stomach is 
in a disturbed state, should consist chiefly of animal broths, 
which, if necessary, may be given by the rectum. At a later 
period more substantial food may be allowed, such as milk, 
eggs, oysters, fish and the like, care being taken that it be not 
only nutritious and easy of digestion, but acceptable to the 
patient's stomach. 



INFANTILE CONVULSIONS. 

Synonyms. — Infantile Fits or Spasms, Infantile Eclamp- 
sia, Eclampsia Infantum; Fr. } Convulsions de VEnfance; Ger., 
Kin derzuckung, KinderJcrampf. 

Definition. — General clonic, epileptiform, acute spasms, 
occurring during infancy and childhood, and produced by 
transitory causes. 

Diagnosis. — It is not always easy to distinguish infantile 
eclampsia from infantile epilepsy. The chief distinctions are 
embraced in the above definition. Eclampsia is an acute dis- 
ease, while epilepsy is chronic; the former depends on some 
permanent or hereditary influence, the latter on some acci- 
dental or transient form of irritation. 

Pathology. — While hereditary influences do not directly 
produce simple eclampsia, they no doubt strongly predispose 
to their occurrence. Xervous susceptibility is another impor- 
tant factor, and this is heightened by the absence of any vol- 
untary restraining influence emanating from the will. But 
the most potent factor is believed to be anaemia. In most 
cases this is both absolute and relative. The child's brain 
contains more water than that of the adult. An anaemic con- 
dition is often induced by the operation of debilitating causes, 
such as impure air, insufficient or unwholesome diet, and other 



130 NERVOUS THERAPEUTICS. 

devitalizing influences to which infants are far more often 
ignorantly or unintentionally than necessarily exposed. 

Therapeutic Indications. — Belladonna. — Head hot and 
throbbing; face deep red or else pale; eyes injected, tremu- 
lous or staring; pupils dilated; intolerance of light; drowsi- 
ness, and starting from sleep as if frightened ; great vascular 
excitement; mouth and tongue dry, with great thirst; pain 
in the neck ; head drawn backward ; great restlessness and 
tossing about; when aroused from stupor answers questions 
with a jerk; indicated in all cases where there is unmistak- 
able evidence of cerebral congestion. 

Grelsemium. — Pain, often severe, in the back of the head and 
neck; great nervous excitement, or else a stupid, comatose 
condition, from which the child is aroused with difficulty; cere- 
bral hyperemia during dentition ; child constantly boring its 
head into the pillow ; delirious as soon as it falls asleep; excess- 
ive irritability; eyes sensitive to light; cramps and spasms 
of the extremities; cries out suddenly from time to time; 
especially indicated in cases produced by heat, or where there 
is marked cerebro-spinal congestion. 

Aconite. — Marked febrile excitement; hot, dry skin; child 
frets, cries out suddenly, gnaws its fists and starts as if fright- 
ened; appears to be in great suffering; very restless ; twitch- 
ing of single muscles ; convulsions caused by fright, cold, 
teething and inflammatory affections, such as otitis, dysen- 
tery, etc. 

Ignatia. — Convulsions return periodically; child screams and 
trembles violently; kicks, jerks and has convulsive twitch- 
ings of single parts ; convulsions extremely violent, with a 
predominance of tonic spasm; indicated after fright, during 
dentition, after being punished, or during the commencement 
of exanthematic fevers. 

Camphor brom. — Anaemic subjects, with pale lips, coldness of 
the body and extremities ; after taking cold ; when preceded 
or accompanied by a watery diarrhoea ; when brought on by a 
suppressed catarrh ; when there is great physical prostration. 

Kali brom. — Head hot and body and limbs cold; feet and 
hands blue and cold ; eyeballs move in every direction; teeth- 



INFANTILE CONVULSIONS. 131 

ing, accompanied by vomiting and diarrhoea; intestines con- 
tracted into a hard ball perceptible to the eye ; great excite- 
ment of both the nervous and vascular systems ; internal as 
well as external spasms ; grinding of the teeth during sleep, 
with moans and cries; indicated where there is cerebral 
anaemia. 

Veratrum alb. — Anaemic subjects, in whom the convulsions 
are attended or accompanied by diarrhoea ; face pale, with 
cold sweat on the forehead ; child trembles all over ; especially 
valuable when the child is very much prostrated after the 
spasm, or when secondary to pneumonia or cholera infantum. 

Cuprum. — The spasm begins in single muscles, or in the fin- 
gers and toes ; is preceded by violent vomiting ; is followed 
by loud cries ; child lies on its face, or turns and twists vio- 
lently until the convulsion is repeated; bloated abdomen, 
with thin, watery, involuntary discharges; child fairly doub- 
les itself up during the spasm ; during dentition in anaemic 
cases. 

Cina. — Convulsive attacks at night or early in the morning ; 
spasms of the extensor muscles, the child becoming suddenly 
stiff, followed by trembling of the whole body ; unusual pallor 
about the nose and mouth, with flushing of the cheeks; child 
grinds its teeth during sleep ; starts and moans during sleep ; 
child is feeble and whines more or less when awake; very 
restless, throwing its arms wildly from side to side ; is very 
feverish, and sometimes delirious, at night. 

Opium. — After the spasm the child lies in a deep stupor ; 
body trembles violently, while the limbs are convulsed ; child 
screams before or immediately after the spasm; indicated after 
fright of the child or of the nurse, or when there is much 
stupor, with retention of urine and faeces. 

Stramonium. — Heat of the head and body, with red face and 
staring eyes ; spasms frequently repeated and continually 
changing their form ; child is frightened by the approach of 
strangers and shrinks from them ; abdomen swollen ; urine 
profuse ; when caused by the suppression of an eruption, or 
when the exanthem fails to make its expected appearance. 

Grlonoin. — Skin hot, face flushed, head drawn back, spasms 



132 NERVOUS THERAPEUTICS. 

unilateral or bilateral ; fainting spells, accompanied by diffi- 
culty of breathing; bowels loose, with greenish, undigested 
stools ; indicated in cases where there is marked cerebral con- 
gestion, attended by palpitations of the heart, dizziness, vomit- 
ing and oppression of breathing. 

Cypripedium. — Reflex convulsions, occurring in children of 
an excitable, nervous temperament, or where there is functional 
irritation of the brain, which renders the child sleepless even 
at night; child's humor is very changeable, being playful at 
one moment and irritable and fretful at another; in cases of 
teething or of intestinal irritation. 

Hyoscyanms. — Congestion of the head; face bloated and 
flushed; convulsive jerks of single muscles, or of a finger or 
hand; jerking and twitching of the facial muscles; grating of 
the teeth during sleep; eyes red and sparkling; child starts at 
every sound ; shrieks from fright or fear ; sickens after eating, 
and perhaps vomits; becomes insensible and froths at the 
mouth; spasms violent and last a long time. 

Zincum. — Child starts and screams out in its sleep ; has a 
startled look when it awakes; the whole body twitches and 
jerks; sometimes the convulsive movements are confined to 
one side or to single limbs or muscles; body hot; restless and 
irritable, especially at night; great appetite; bloated abdomen ; 
anaemic children during the process of teething. 

Nux vom. — Spasms very easily renewed, and followed by deep 
sleep; when caused by indigestion, or by emotional excite- 
ment in the nurse. 

Stannum. — Irritative fever from worms, but with more excite- 
ment, more cerebral irritation and more fear than in Cina; 
convulsions from dentition or intestinal irritation. 

Cicuta. — Sudden and unexpected attacks of severe tonic con- 
tractions, affecting the whole body, and making it stiff and 
straight or bending it backward ; clonic convulsions affecting 
the head and upper portion of the body; muscular spasms 
renewed by the least excitement of the. child, or depending on 
verminous irritation. 

Chamomilla. — Extreme restlessness, child exceedingly cross 
and worrisome, can only be pacified by being carried about in 



POSTNATAL CONVULSIONS. 133 

the nurse's arms; disordered condition of the stomach and 
bowels; muscles of the face and limbs twitch and jerk violently 
from intestinal irritation, or from nursing a woman who has 
just bad a fit of anger and whose milk does not agree. 

Helleborus. — Convulsions of cerebral, or of apparently idio- 
pathic origin; intense pain in the head; urine dark, scanty 
and frequently emitted; convulsions followed by sudden re- 
laxation of the whole body, leaving the body cold and with a 
cold sweat on the forehead; tonic spasms of the cervical 
muscles. 

Ipecacuanha. — Great irritation of the stomach and bowels; 
frequent vomiting; convulsive attacks caused by indigestible 
food, or by a suppressed exanthem. 

Physostigma. — Convulsions caused by reflex irritation of the 
spinal nerves, especially when preceded by twitching and 
trembling of the muscles, dizziness and great weakness in the 
lower extremities; intestinal irritation produced by cold, 
worms, dentition, etc. 

Veratrum vir. — Convulsions secondary to pneumonia, or when 
attended by fever, cough or diarrhoea ; face pale, or bluish and 
cold, or covered with cold perspiration; violent vomiting, 
which is immediately renewed on taking the least food or 
drink; convulsive twitching of the muscles of the face and 
limbs, which are cold and damp, or covered with a cold per- 
spiration. 

Auxiliary Treatment. — There is perhaps no disease in 
which accessory treatment is of greater importance, in most 
cases, than in infantile convulsions. This will be evident by 
a moment's consideration of the fact that the causes are almost 
innumerable, and that unless the cause be removed a perma- 
nent cure cannot be expected. This suggestion may be all 
that is required under this head; if not, the reader will find 
the whole subject treated at length in the author's Treatise on 
Diseases of the Nervous System, pp. 37-40. 

POSTNATAL CONVULSIONS. 
Synonyms. — Convulsions of the New-Born, Eclampsia 



134 NERVOUS THERAPEUTICS. 

Neonatorum, Trismus Xascentium; Fr., Trisrae de I'Enfance; 
Ger.y Eklampsie der Neugeboren, Kinder starrkrampf. 

Definition. — Spasmodic muscular contractions, of a tonic or 
clonic character, occurring shortly after birth. 

Diagnosis. — The time of their occurrence, which is usually 
on or about the fifth day after birth. (very rarely earlier than 
the second day, or later than the tenth), is sufficient to dis- 
tinguish them from ordinary infantile convulsions, with which 
alone they are liable to be confounded. 

Pathology. — Out of nine cases, Schuetz found haemorrhages 
six times in the intracranial cavity and twice in that of the 
spinal cord, while in only two instances did he observe inflam- 
mation and ulceration of the umbilicus, to which at one time 
they were supposed to be due. He therefore thinks that when 
by some unknown causes haemorrhages occur in either the 
cranial or spinal cavities, and produce sufficient pressure on 
certain nervous parts, "reflex manifestations and involuntary 
motions will follow, attacking larger or smaller complexes of 
muscles," in other words, producing general or partial convul- 
sions. 

Clinical Experience. — This has been anything but flatter- 
ing. Cures, however, have been reported from the use of Hy- 
pericum, Passiflora, Arnica, Cicuta and Calcarea. 

Therapeutic Indications. — These have already been given 
under the head of infantile convulsions, which see. 

Auxiliary Treatment. — As the disease very rarely occurs 
among infants that are kept dry and clean, in a pure atmos- 
phere and with comfortable surroundings, it is evident that 
hygienic measures are of primary importance, both in a pro- 
phylactic and therapeutic point of view. 

PUERPERAL CONVULSIONS. 

Synonyms. — Convulsions of Pregnancy and Parturition, 
Puerperal Eclampsia, Uraemic Convulsions, Eclampsia Gravi- 
darum et Parturientium ; Fr., Convulsions des Femmes Enceintes 
et en Couche; Ger., Eklampsie in der Schwangerschaft und im 
Wochenbett. 



PUERPERAL CONVULSIONS. 135 

Definition. — Convulsions occurring during pregnancy, dur- 
ing labor, and immediately at or soon after delivery. 

Diagnosis. — This is obvious from the condition of the pa- 
tient and the history of the case. 

Pathology. — Albuminuria exists in almost every case of 
puerperal convulsions ; and as albumen and urea in the urine 
are in inverse proportion to each other, that is to say, when 
there is much albumen there is little urea, and when there is 
much urea there is little albumen, it is a generally accepted 
fact that most, if not all, cases of puerperal convulsions are due 
to the poisoning of the blood with urea, either directly or by 
the carbonate of ammonia produced by its decomposition. 

Clinical Experience. — The post hoc ergo propter hoc argu- 
ment has led to the acceptance of a very large number of rem- 
edies as specifics in this disease. Making proper allowance for 
this fact, the following list is entitled to confidence, provided, 
of course, the remedies are always given agreeably to their 
therapeutic indications: Cuprum, Hydrocyanic ac, Arsenicum, 
Hyoscyamus, Bryonia,, Stramonium, Digitalis, Pilocarpus, Ascle- 
pias syr., Veratrum vir., Gelsemium, Belladonna, Opium, Lachesis, 
Ignatia and (Enanthe croc. The following remedies will pre- 
vent, it is said, the full development of threatened convul- 
sions if given in time: Apis, Helonias, Apocynum can., Eupato- 
rium purp., Kalmia and Barosma. 

Therapeutic Indications. — Cuprum. — Convulsions alter- 
nate with delirium and nervous dyspnoea; are followed by 
blindness or deafness, or by apathy and great indifference ; 
during the paroxysm the face is red and distorted, eyes pro- 
truding and staring, tongue and breath cold ; spasms chiefly 
affect the extensor muscles; patient frequently screams out, as 
if in great anguish. 

Hydrocyanic ac. — Convulsions occurring suddenly, and at- 
tended by great depression, slow, moaning breathing and in- 
sensibility ; spasms, partial or general, with great distortion of 
the features and limbs, or with the trunk bent forward ; spasm 
of the larynx, with symptoms of suffocation ; inability to swal- 
low ; rattling in the trachea ; extreme anguish ; action of the 
heart greatly diminished ; extreme prostration. 



136 NERVOUS THERAPEUTICS. 

Arsenicum. — Tonic and clonic spasms, with great distortion 
of features, limbs stiff and hands clenched ; after the parox- 
ysm the patient exhibits great exhaustion ; sudden sinking of 
strength, with faintness; lies in a stupor like one dead, 
breathing imperceptibly. 

Hyoscyamus. — Clonic convulsions, either partial or general, 
violent, accompanied by shrieks and great oppression of the 
chest ; face pale, with cold perspiration, or bluish-purple and 
bloated ; unconscious and delirious ; extensor muscles violently 
convulsed. 

Bryonia. — Convulsive jerking of the extremities, beginning 
in the fingers and toes and extending to the whole limb ; 
cramps in the knees and calves of the legs ; worse in the morn- 
ing and after eating ; drawing sensation along the spine, fol- 
lowed by violent contraction of the extensor muscles, bending 
the body backward like a hoop; face red and bloated"; very 
apprehensive as to recovery. 

Stramonium. — Patient very excitable, hysterical, delirious, and 
has frightful or agreeable visions, with corresponding moods 
and actions, laughing, singing, attempting to escape, etc. ; con- 
vulsive movements of every muscle, distorting the face, body 
and limbs ; convulsions easily excited and frequently renewed. 

Digitalis. — Frequent convulsions, with drowsiness and insen- 
sibility ; heart greatly embarrassed, weak and palpitating, and 
frequently intermits. 

Pilocarpus pennai— Puerperal convulsions, attended with high 
arterial excitement, hard pulse, heavy blood pressure ; perspi- 
ration, with free flow of saliva ; dyspnoea, threatening suffo- 
cation. 

Asclepias syr. — Ursemic convulsions, preceded by severe 
headache, with sharp pains through the temples, or with a 
sense of constriction across the forehead, full, quick pulse, and 
nausea or vomiting ; attacks preceded by profuse, then scanty 
or suppressed urine. 

Veratrum vir. — Convulsions attended by high arterial excite- 
ment, violent delirium, flushed face, thirst, hot and sensitive 
skin, followed by a weak, scarcely perceptible pulse, and cold, 
clammy skin, dilated pupils and oppressed breathing. 



PUERPERAL CONVULSIONS. 137 

Gelsemium. — Passive congestion of the head and face, stupid 
look, thick speech, slow, full pulse; labor protracted by rigid 
os uteri ; apoplectiform convulsions during labor. 

Belladonna. — Active or passive cerebral congestion ; face red 
or livid, pupils dilated, speech thick or lost; convulsions par- 
tial or general, frequently repeated and attended by loud 
cries, contortions of the face and delirious mutterings ; parox- 
ysms followed by quiet, unconscious sleep, or by disturbing 
spasmodic movements and visions. 

Opium. — Ursemie coma following puerperal convulsions ; con- 
vulsive rigidity of the body ; red, bloated face and stertorous 
breathing ; retention of stool and urine ; low, incoherent mut- 
tering ; apoplectiform convulsions during or after labor. 

Lachesis. — Convulsions continue longer and are more severe 
about the throat than elsewhere ; complains of pains without 
being able to locate them ; redness of the face, violent convul- 
sions of the facial muscles and jerking of the extremities, most 
violent on the left side ; trembling of the body and limbs be- 
tween the paroxysms. 

Ignatia. — Great nervous excitement, manifesting itself in 
cries, sobs and paroxysms of laughing ; loquacious and then 
taciturn ; tries to kick the cover off the bed ; constantly pull- 
ing at her hair; urine turbid and scanty; suffocative fits of 
breathing ; panting between the spasms, which are often lim- 
ited to the muscles of the upper part of the body, the neck and 
the face. 

(Enanthe croc. — Epileptiform convulsions, with swollen and 
livid face, followed by coma or deep sleep, or else with syncope, 
insensibility and deathlike coldness; apoplectiform convul- 
sions, with convulsive respirations, dilated pupils, insensibility, 
feeble pulse and great prostration ; wildly delirious ; tetanic 
contraction of the limbs. 

Auxiliary Treatment. — As a general rule the sooner the 
womb is emptied of its contents the better, as this alone often 
suffices to put an end to the convulsions. When, therefore, 
the spasms occur during labor, artificial delivery should be 
speedily effected, unless there is some weighty reason for 
deferring the operation. The same is often true when the con- 
10 



138 NERVOUS THERAPEUTICS. 

vulsions set in previous to labor, provided they seriously 
threaten a miscarriage. Even when they occur subsequent to 
parturition it is important to remove any clot, membrane or 
portion of the placenta which may have been retained, as the 
convulsions seldom, if ever, entirely cease so long as any of the 
contents of the womb remain in the uterine cavity. 

TOXEMIC CONVULSIONS. 

Synonyms. — Convulsions from Poisoning of the Blood, 
Uraemic Convulsions, Cholaemic Convulsions, Convulsions from 
Inanition, Eclampsia Toxica; Fr. } Convulsions Toxemiques; 
Ger.j EMampsie-blutvergiftwig, Tozamische Eklampsie. 

Definition. — Convulsions resulting from the introduction 
or retention of poisonous substances in the blood. 

Diagnosis. — As in other forms of eclampsia, the history of 
the case, together with the appearance of the patient, is usually 
sufficient to establish the diagnosis. Thus, ursemic convul- 
sions occur either in connection with parturition or disease of 
the kidneys; cholasmic convulsions result from the introduc- 
tion of decomposing products of animal secretions into the 
blood ; and the convulsions of inanition are induced by the 
intoxicating effect of the deteriorated blood upon the nervous 
centres. 

Pathology. — The pathology of ursemic convulsions occur- 
ing in connection with parturition is given in the previous 
section, which see. They likewise occur in the course of scar- 
latina in consequence of sudden obstruction of the urinary 
passages with croupous exudation. They may also be pro- 
duced by any affection of the kidney, such as Bright's disease, 
which interferes with the secretion of urine, or by a re-absorp- 
tion of urine which has been previously effused into the cellu- 
lar tissue, especially after the urine is decomposed and the 
blood becomes surcharged with the carbonate of ammonia 
(ammonisemia). Cholsemic convulsions occur most frequently 
in acute atrophy of the liver, as on account of the destruction 
of the hepatic cells the function of the liver then ceases. In 
short, whenever from any cause the blood becomes so impure 



EPILEPSY. 139 

as to irritate the convulsive centre in the medulla oblongata, 
toxsemic convulsions are the result. 

Clinical Experience. — All worth mentioning will be found 
under the heads of cerebral hyperemia, cerebral ansemia and puer- 
peral convulsion*, which see. 

Therapeutic Indications. — See previous sections, especi- 
ally those pertaining to convulsions. 

Auxiliary Treatment. — Hygienic measures, especially 
such as will tend to purify the blood, are of the highest im- 
portance. Hence pure air, water, and a blood-making diet of 
beef and other animal food, are required in all cases. Mas- 
sage is also of great benefit by its renewing effect upon the 
tissues. 

EPILEPSY. 

Synonyms. — The Falling Sickness, Morbus Magnus, M. 
Major, M. Dsemonius, M. Divinus, M. Deificus, M. Lunaticus, 
etc., Epilepsia, Epilepsis ; Fr., Epilepsie, Mai Divin, Haut Mai; 
Ger., Fallsucht. 

Definition. — A chronic, non-febrile, nervous affection, char- 
acterized by paroxysms of loss of consciousness and, with very 
rare exceptions, by tonic and clonic convulsions. 

Diagnosis. — Is there any way of positively diagnosing an 
epileptic paroxysm, as such, without reference to its history ? 
Xo ! Eclamptic and epileptic convulsions accompanied by loss 
of consciousness belong to the same group of symptoms ; the 
only difference is they occur under different conditions. The 
one is acute or transitory, the other chronic, and recurs in 
conformity to an established epileptic habit. No doubt there 
is such a thing as infantile epilepsy, but such cases are indeed 
very rare. Up to about the third year of life the epileptic 
habit is not likely to become established, while after that 
period local irritations, either internal or external, are not 
likely to cause convulsions without the pre-existence of an 
inherited morbid state of the nervous centres. 

Epilepsy is liable to be mistaken for hysteria, which is not 
only chronic, but often simulates epilepsy very closely. In 
epilepsy the loss of consciousness is sudden and genuine ; 



140 NERVOUS THERAPEUTICS. 

there is no recollection of the attack afterward ; the eye is 
fixed, the features often distorted and the tongue bitten. In 
hysteria, on the other hand, the attack is not sudden, con- 
sciousness is not entirely lost, and there is no reckless injury 
of the tongue or person. 

Syphilitic epilepsy may be distinguished from idiopathic 
epilepsy by the fact that it occurs in those who have not had 
epilepsy in early life and who have reached the age of at least 
thirty years; the disease is frequently associated with or is 
followed by some form of paralysis, generally partial; the 
attacks are frequently preceded by headache, likewise partial, 
and the convulsions occur often, that is, many in quick suc- 
cession, the interval between the series of attacks being com- 
paratively long ; the periods of quietude, however, are not free 
from headache or other nervous symptoms which exist and 
often become aggravated — conditions contrary to what usually 
obtain in simple or idiopathic epilepsy. 

Pathology. — Although no constant anatomical changes 
have yet been observed in this disease in any of the great 
nerve centres, the fact that it is in most cases an hereditary 
affection, and chronic in its nature, renders it almost certain 
that it is something more than a mere functional disorder, 
and this accords with the latest investigations, which go to 
show that it depends, in a measure at least, on certain histo- 
logical changes in the medulla oblongata. Cortical epilepsy 
is only a peculiar form of peripheral epilepsy, the cortical 
irritation being reflected upon the convulsive centre or cen- 
tres in the medulla, as in other cases of reflex epilepsy. 

Clinical Experience. — Notwithstanding the universally 
admited fact that genuine epilepsy is extremely difficult of 
cure, the number of remedies to which such cures have been 
assigned are almost too numerous to mention. I shall there- 
fore refer here to only a few of those whose recorded cases are 
before me. Indigo is said to have cured a case where the men- 
tal symptoms were those of melancholy. Dr. Quezada says 
that when he was a boy, aged 13, he had fourteen epileptic 
attacks, and that he was permanently cured by the fruit of 
Capparis cor., or "simulo," a plant indigenous in Peru. Dr. 



EPILEPSY. 141 

Foster prescribed Cannabis ind. in a case of forty years' stand- 
ing — in which an unfailing premonition of an approaching 
attack was a feeling of extraordinary mental and physical 
vigor — in doses of one-tenth of a drop every hour when she 
felt thus "exalted," with the result that she has had but one 
slight seizure since she began the use of it, now nearly three 
years, while before she had about thirty annually. Glonoin, 
2x dil., is said to have cured many cases. Calcarea ars., rec- 
ommended by Dr. Hering, is said to have benefited several, 
and entirely stopped a few cases. Dr. Buller claims to have 
cured epilepsy with Cotyledon umb. Belladonna is credited 
with a large number of cures, but as most of them occurred in 
children, I am inclined to regard most of them as cases of 
ordinary infantile convulsions. Cocculus, according to Hughes, 
has made several undoubted cures. Cuprum acet, 3x, cured a 
case where every usual remedy had failed, fifteen years having 
since elapsed without any return. Nux vom., 3x, cured a case 
of sixteen years' standing; four years have passed without 
any return. Hydrocyanic ac, 3x, has cured, according to Dr. 
Hughes, several cases of recent date. Argentum nit, lx, 2x, 
has effected several permanent cures. Thaspium, 3x, has, it is 
said, cured two genuine cases. CEnanthe croc, is also credited 
with a cure. 

Therapeutic Indications. — Indigo. — Exceedingly depressed 
and melancholy; great languor and weariness; unusual feeling 
of prostration, especially in the lower limbs: convulsions pre- 
ceded by a fit of the blues; the aura seems to come from the 
abdominal ganglia; sometimes the attack begins with dizzi- 
ness. 

Capparis cor. — Fit occurs suddenly, almost without warning; 
convulsions terrific, tonic and clonic, general, with foaming at 
the mouth, usually reddened with blood from a bitten tongue; 
very stupid for a long time after the fit has passed off. 

Cannabis ind. — Fit immediately preceded by a feeling of ex- 
traordinary mental and physical vigor; mind and body in a 
state of ecstatic exaltation; on regaining consciousness violent 
shocks pass through the brain; some cases are preceded by 
active cerebral congestion, throbbing, ringing and buzzing in 
the ears, sensitive to light and noise. 



142 NERVOUS THERAPEUTICS. 

Grlonoin. — Attacks immediately preceded by flushed face, 
headache, ringing in the ears and other evidences of cerebral 
hyperemia; increased action of the heart and arteries; nausea 
and vomiting, dizziness and oppression of breathing; convul- 
sions tend to become more and more frequent. 

Belladonna. — Recent cases, with decided brain symptoms; 
previous to the attack, headache, throbbing in the temples, 
dilated pupils, intolerance of light, redness of the face; after 
the attack, anxiety, fear of imaginary things, disturbed sleep, 
vertigo, peevishness, flushed face, startings during sleep ; con- 
vulsions commence in the upper extremities; clutching of the 
throat during the fit. 

Cocculus. — Debilitated, nervous subjects; circulation sluggish, 
a sort of passive congestion, veins standing out like whip-cords; 
vertigo, with nausea; great lassitude, making it difficult to 
stand firmly; convulsions begin in the fingers and toes. 

Cuprum. — Convulsions follow each other in rapid succession, 
the convulsive state rather remitting than completely inter- 
mitting; aura emanates from the region of the stomach; 
patient very restless after the attack, with headache, soreness 
of the flesh and prostration; convulsions begin in the extremi- 
ties; hands and feet cold, face livid or pale; involuntary dis- 
charge of urine; hysterical mood. 

Nux vom. — Stomach weak and disordered, tender to the 
touch; pressure over the stomach renews the attack; convul- 
sive twitching in the limbs and trembling of the whole body; 
spinal epilepsy. 

Hydrocyanic ac. — Recent cases, attended by sudden and com- 
plete loss of consciousness and sensation; body blue and cold; 
fit quickly merges into a comatose condition, interrupted only 
by a renewal of the convulsive movements, which usually 
begin in the extremities and afterward become general ; great 
drowsiness and prostration after the fit. 

Argentum nit. — Pupils dilated a day or two before the attack ; 
aura rises slowly from the region of the stomach, which feels 
oppressed as by a load resting upon it; head feels dull and 
stupid; mind exceedingly depressed and melancholy; convul- 
sions sometimes preceded by active cerebral congestion. 



EPILEPSY. 143 

Thaspium aur. — Flushed cheeks, hot head, visible pulsations 
of the carotid and temporal arteries; great exhilaration or 
groat mental depression; hysterical mood; headache, with 
nausea, precedes the attack. 

(Enanthe croc— Convulsions attended with vertigo, nausea, 
vomiting, unconsciousness, coma or deep sleep; convulsions, 
with deathlike syncope, coldness as if dead; tetanic contrac- 
tion of the muscles of the jaws and limbs; convulsions epilepti- 
form in all cases, pupils dilated, e} T eballs turned up, frothing at 
the mouth, face swollen and livid; madness with the convulsions. 

Chininum ars. — Attack followed by cold perspiration, eructa- 
tions and a sense of utter prostration. 

Plumbum. — Convulsions preceded by numbness of the legs; 
swollen tongue; consciousness returns slowly and imperfectly; 
chronic cases. 

Silicea. — Attack preceded by shaking of the left arm and 
great coldness of the left side of the body; slumber, with start- 
ing; spasms seem to undulate from the solar plexus toward 
the brain; violent screaming, groaning and foaming at the 
mouth, followed by warm perspiration, slumber and paralysis 
of the right side. 

Auxiliary Treatment. — A large proportion of these cases 
belong to the reflex variety, and depend upon causes which 
can be removed during the interval between the attacks. One 
case of fifteen years'* standing was accidentally cured in treating 
the piles. Another was caused by the larvae of flies in the in- 
testines, the removal of which speedily cured the patient. 
Many cases depend on some disturbance or irregularity of the 
menstrual function, which requires to be corrected. But the 
most numerous of those occurring among young persons, of 
both sexes, are the result of self-abuse, and require not only 
great care and surveillance on the part of parents and guar- 
dians, but moral treatment as well. 

The fathers of medicine very properly laid great stress upon 
the importance of a suitable diet in epilepsy. Celsus and 
Aretceus advise "a soft diet free from crudities." Boerhaave 
says that "great frugality in diet cures epilepsy." Echeverria 
says that "diet and exercise are of more value than medicine." 



144 NERVOUS THERAPEUTICS. 

Experience shows, however, that there is no specific diet suit- 
able for all cases of epilepsy. Some recommend a meat, others 
a milk, farinaceous or vegetable diet; but the experiments of 
Merson, Gowers and others show that, applied indiscriminately, 
neither of these kinds. is curative. At the same time there is 
no doubt that purely vegetable food and a milk diet has pro- 
duced many a lasting amelioration. My own opinion, how- 
ever, is that this sort of diet is best suited to full-blooded, 
plethoric patients, while meat diet is best adapted to weakly, 
anaemic ones. Nocturnal cases are also, as a rule, benefited 
by a stimulating meat diet, while those occurring during the 
daytime require an unstiniulating, milk or vegetable diet. 
Excesses in eating and drinking should never be allowed ; and 
as for alcoholic drinks, smoking, and even coffee and tea, they 
had best be entirely prohibited. 

TETANUS. 

Synonyms. — Spasm with Rigidity, Lock-jaw, Central 
Myelitis, Entasia Tetanos, Trismus ; Fr., Tetanos; Ger. : 
Starrl-ra.mpf. 

Definition. — A disease characterized by a rigid contraction 
of the voluntary muscles, alternating with a greater or less 
degree of relaxation, caused by an irritated or overexcited 
state of the medulla oblongata and spinal cord. 

Diagnosis. — Tetanus is not likely to be mistaken for any 
other natural disease, unless it be hysteria, which sometimes 
bears a slight resemblance to it. The history, duration and 
characteristic symptoms 'of the two diseases are, however, 
amply sufficient to distinguish them from each other. Not 
so, however, with toxic tetanus, especially that form of it pro- 
duced by strychnia : and as the latter is frequently employed 
for purposes of murder and suicide, it is important to be 
able to discriminate between the natural and the artificial 
disease. In the former the spasm first takes the form of 
trismus or lock-jaw, while in the latter the lower extremities 
are first involved; the hands also are generally affected in 
these cases, while in the natural disease the upper extremities 



TETANUS. 1 l~> 

usually escape altogether. Not only so, but the duration of 
tetanus is usually much greater than that of the tetanoid 
affection produced by strychnia, which generally proves fatal 
within less than an hour of its commencement. 

Pathology. — Various lesions of the spinal cord have been 
discovered after death from tetanus, the most important of 
which consist in an enlargement of the bloodvessels, together 
with granular disintegration of the nerve-tissue; but as many 
easts occur in which no pathological changes can be detected, 
at least nothing sufficient to account for the convulsions, it is 
by no means certain that these alterations are the causes, or 
only the effects, of the tetanic manifestations. Indeed, there 
are circumstances which seem to indicate that the spinal cord 
is not the primary centre of reflex action in these cases, but 
that the morbid influence, whatever it may be, that causes the 
disease, is first transmitted to the medulla oblongata, and 
afterward extends to the cord. 

Clinical Experience. — The following remedies have been 
used successfully in tetanus in a number of instances : Bella- 
donna, Atropine, Narcotin, Cicuta, Passiflora, Gelsemium, Physos- 
tigma, Stramonium, Lachesis, Hydrocyanic ac, Angus, vera, Ver- 
atrum vir., Arnica and Hypericum. Among the homoeopathic 
remedies which have greatly ameliorated cases of tetanus are: 
Aconite, Hyoscyamus, Phytolacca, Kali brom., Bryonia, Cuprum, 
Arsenicum, Nux vom., Ignatia, Cannabis ind. and Curare. 

Therapeutic Indications. — Belladonna. — Cerebro-spinal 
congestion; stiffness- of the jaws, with convulsive movements, 
dilated pupils, difficult deglutition, staring eyes, restlessness, 
spasmodic respiration, involuntary discharges of urine ; sudden 
jerks and shrieks during sleep; opisthotonos; pleurosthotonos, 
especially to the left side. 

Nicotinnm. — Icy coldness of the limbs; violent tetanic spasms, 
succeeded by relaxation and trembling; extreme palor, nausea 
and prostration ; coldness and shuddering of the whole body ; 
dry, hot skin, with thirst and quick pulse, succeeded by cold 
skin, weak, thready pulse and labored, irregular breathing. 

Cicuta vir. — Trismus; legs and arms flexed and rigid; 
abdomen distended and hard; spasms every half hour; edges 



146 NERVOUS THERAPEUTICS. 

of the tongue covered with white ulcers; spasms of the oesophagus; 
spasms of a tonic character; paleness of the face during the 
spasm. 

Passifiora incar. — Violent tetanus, with opisthotonos, trismus 
and convulsions in a child two years old ; produces, it is said, 
prompt, perfect and permanent cures in both men and horses, 
also in trismus nascentium. 

Gelsemium. — Traumatic tetanus; stiffness of the jaws, with pain 
and stiffness in the back of the neck; spasmodic feeling in the 
pharynx and oesophagus, with difficulty of swallowing; con- 
strictive feeling in the chest, with great difficulty of breathing; 
pupils dilated ; cramps in the legs; convulsive action of the 
voluntary muscles; involuntary discharges of faeces and urine; 
abdominal muscles rigid; darting pains in the wounded leg, 
which jerks and twitches whenever it is touched; hard, feverish 
pulse; breathing irregular and hissing. 

Physostigma. — Twitching and trembling of the muscles ; 
trembling, convulsive action of the respiratory muscles; 
tendency to fainting; alternate dilatation and contraction of the 
pupils, the former corresponding with the period of the spasm, and 
the latter with that of quiescence ; opisthotonos; no control over 
his urine, which is passed involuntarily. 

Stramonium. — Traumatic tetanus; opisthotonos; apoplectic 
condition, with snoring, red face and deep sleep; body hot; 
urine copious; grinding of the teeth; contortion of the hands; 
shuddering; spasmodic constriction of the oesophagus; con- 
striction of the chest, with difficult breathing; forehead cold; 
pulse scarcely perceptible; lower limbs drawn up with great 
force, then straightened out and so rigid that they could not 
be bent; eyes tightly closed, with occasional twitching; 
wounded hand swollen and erysipelatous. 

Lachesis. — Tetanic look, with half-closed eyes and stiffness 
of the neck; trismus; opisthotonos; rigors; shooting pains in 
the back; throat sensitive to contact and swallowing almost 
impossible; two cases cured. 

Hydrocyanic ac. — Tetanic spasms, with trismus, protruded 
and glistening eyes, bloated face and neck; passive cerebral 
congestion. 



TETANUS. 147 

Angustura vera. — Violent tetanic paroxysms, with opistho- 
tonos; twitching and jerking along the back, like electric shocks; 
tetanic spasms excited by the least touch, noise or the drink- 
ing of tepid water; thirst, without any desire to drink; pulse 
intermittent but rapid. 

Veratrum vir. — Tetanus depending on pneumonia; opistho- 
tonos; no relaxation of the muscles of the back for five days; 
heels almost touched the head like a hoop ; body covered with 
a cold, clammy sweat ; remedy not prescribed until after the 
febrile reaction had set in. 

Arnica. — Traumatic tetanus; internal chilliness with ex- 
ternal heat; pulse variable, mostly hard, full and quick; 
muscles and limbs twitch and jerk ; weary, bruised feeling, 
making everything feel too hard; breathing short and panting; 
face hot, body cold; jerks and electric-like shocks; tremor of 
the limbs. 

Hypericum. — Traumatic tetanus, with trismus and opistho- 
tonos; swallowing difficult; hardness of the cervical muscles; 
face distorted; nostrils dilated; no relapse. 

Auxiliary Treatment. — Warm baths ; sweating, produced 
by passing hot air inside a covered framework adjusted to the 
bed by means of a tube connected with a heated cylinder; 
flannel cloths wrung out of hot water, of a temperature just 
bearable to the hand, and applied to the nape of the neck and 
along the spine; ice, and the spinal ice-bag; and the division 
or stretching of any nerve-trunk connecting the wound with 
the spinal cord, have all been resorted to with more or less 
benefit in different cases. 

In order to support the patient during the severe illness 
through which he is passing, he should be made to swallow, 
if possible, an egg, or half an ounce of raw meat juice, mixed 
with three or four ounces of milk, every four or five hours 
during the day. If great exhaustion ensues, or the patient is 
unable to swallow, peptones, or beef-tea and brandy, should be 
given per annum. 



148 NERVOUS THERAPEUTICS. 

HYDROPHOBIA. 

Synonyms. — Dog Madness, Canine Madness, Lyssa, Rabies; 
Fr., La Rage, Hydrophobic; Ger., Hundswuth, Tollwuth, Wasser- 
scheu. 

Definition. — An acute spasmodic disease, allied to tetanus, 
produced by the inoculation of a specific animal poison, usually 
through wounds made by animals suffering with rabies, the 
symptoms indicating great disturbance of the central nervous 
system. 

Diagnosis. — The diseases most liable to be mistaken for 
hydrophobia are tetanus, spurious hydrophobia and acute 
mania. In tetanus the result usually follows the injury within 
a week or ten days; in hydrophobia it seldom occurs short of 
two or three weeks, and is often delayed many months. In 
tetanus, again, the convulsions are continuous, and are usually 
combined with trismus; moreover, there is no mental distur- 
bance, no increase in the secretion of saliva, and no well- 
marked respiratory spasm, as we find in hydrophobia. 

Spurious hydrophobia, from the great resemblance of its 
symptoms to those of the genuine disease, is more difficult of 
detection. Such cases, however, usually occur in the hysteric 
constitution, present a less serious aspect, are free from any 
mental derangement except what arises from fear or anxiety, 
and are more easily subdued by treatment. 

From acute mania the affection may be distinguished by 
the history of the case, the rapid course of the disease, and the 
persistency with which the convulsive paroxysms, which are 
never absent, return.. 

Pathology. — The morbid appearances in the medulla ob- 
longata and spinal cord, as described by Allbutt, Benedek, 
Cbates, Gowers and others, consist mainly of changes in the 
nerve-cells and vessels — the pressure of round cells; leucocytes 
in the perivascular spaces, in the nerve- tissue itself, and among 
the nerve-elements; granular degeneration, and even embo- 
lism; the changes being most marked about the respiratory 
centres in the medulla. None of these lesions, however, are 
characteristic; they throw little light on the essential nature 
of the disease, as similar changes are observed in other affec- 



HYDROPHOBIA. 149 

tions. Gower's opinion, which is substantially that of other 
pathologists, is, "that the vascular changes, from their vari- 
ability and occasional absence, are probably secondary effects 
of the disturbed action of the nerve-centres produced by the 
poison carried by the blood." 

Clinical Experience. — The most interesting, and, in some 
respects, perhaps the most important clinical experience in 
this disease, is that of M. Pasteur on the protective power of 
inoculation. The results, for which alone we have room, are 
so far, I am sorry to say, very unsatisfactory. The}^ may be 
summed up as follows: (1) Animals which have been inoculated 
hypodermically by M. von Frich, after Pasteur's method, have 
not been protected from infection with the fresh virus of street 
rabies, and have only exceptional^ escaped after intracranial 
infection, although inoculated during ten days with virus of 
progressive virulence (medulla from ten days to one day). 
This result is diametrically opposed to that claimed by Pasteur 
himself, who asserts that animals so treated are proof against 
any ordinary inoculation. (2) M. Pasteur, having attributed 
the unsatisfactory results obtained by M. von Frich to too slow 
vaccinations, recommended a more intensive mode of treat- 
ment, whereupon M. von Frich instituted a fresh series of 
experiments, w T hich he carried out conformably to M. Pasteur's 
instructions, but with no more favorable result; all the ani- 
mals died of rabies. (3) Most of the animals which were sub- 
mitted to the preventive treatment after subcutaneous inocula- 
tion with street rabies died of the disease, even when the 
period of incubation was thirty-four days. These experiments 
show, as claimed by M. von Frich, that Pasteur's method of 
rendering animals refractory to rabies is not yet either sure or 
certain. There is not yet a sufficient scientific basis for the 
application in man of a preventive treatment after the bite of 
a rabid animal. It is, moreover, quite possible that the pre- 
ventive treatment, at any rate the intensive method recently 
recommended by M. Pasteur, may itself transmit the disease. 

As for the curative power of medicine in hydrophobia, we 
can only say that a "prodigious" number of remedies lay 
claim to it, as the following list will show : 

Xanthium spin. — This remedy has been declared by Dr. 



150 NERVOUS THERAPEUTICS. 

Grzyvala, of Podolia — for whose truthfulness Prof. Gubler, of 
Paris, vouches — a specific for hydrophobia. He says that dur- 
ing the Crimean war a family of twelve persons had been 
bitten by a hydrophobic wolf; six of them entered his wards 
at Olschanka, Podolia; they were treated with an infusion of 
the leaves of this remedy, and all recovered; the other six, who 
were treated by the actual cautery and the daily use of Genista 
tinctoria and other drugs, died in the course of from twelve to 
sixty days. He recounts many other cases, and says that out 
of at least one hundred cases he has not failed to save every 
one. Out of a herd of thirty oxen bitten by a mad wolf, eight 
succumbed to hydrophobia; the commissary of police obtained 
the "anti-rabic" powder of Dr. G. and gave three ounces daily 
to each of the others, saving every one of them. 

Hoang-Nan. — M. Perrier, missionary at Tonquin for twenty 
years, declares that he has cured a young girl of 14 of hydro- 
phobia with this remedy; she afterward grew up, married, 
and is now a mother. 

Spiraea ulmar. — Kuhner, of Russia, says that during a frantic 
paroxysm of hydrophobia a patient devoured a piece of the 
root of this plant; fifteen minutes afterward he became con- 
scious, vomited, and fell into a profound sleep of twenty-four 
hours, and was well afterward. 

Inula helen. — Dr. Helmuth cites the following cure by this 
remedy: In 1858 a policeman, so far gone with hydrophobia 
as to have to be held in the carriage in which he was being 
driven to Germantown to the residence of Mr. Frye, was 
treated exclusively with Inula helenium with success. 

Tanacetum vulg. — M. Hay em, in the name of M. Peyraud, of 
Libourne, has shown the resemblance which exists between 
true rabies and what he calls tanacetic rabies, that is to say, 
rabies caused by the essence of tansy. . " If rabbits," says M. 
Peyraud, "on whom one has previously practiced the injections 
of tansy for a period of six, seven or eight days, be submitted 
to the action of rabic virus, it will prevent these animals from 
developing rabies. All of those to which I have given this 
preventive treatment, during the past eight months, have not 
been attacked by rabies, while two rabbits which I had inocu- 
lated with rabic virus without having previously submitted 



HYDROPHOBIA. 151 

them to the preventive tanacetic injections, have both of them 
succumbed to the true rabies, one very rapidly, the other more 
slowly." This is true homoeopathy, and therefore a great im- 
provement on Pasteur's method, even if all that is claimed for 
the latter is true, which is very far from being the case. 

The following remedies have also been favorably reported 
upon in this disease: Scutellaria (Vanderveer), Belladonna 
(Adams), Euphorbia (Ruddock), Lachesis (Toothaker), Stramon- 
ium (Morgan), Hydrophobia (Berridge), Tabacum (Norton), 
Cannabis ind. (Ruxton), Mercvrius corr. (De Capua), Gelsemium 
(Dubbs), Simaruba Cedron (Valiant), Genista lutea (Fox), Can- 
tharis (Hartlaub), Hyoscyamus (Hahnemann). 

Therapeutic Indications. — These will be found in previous 
sections, especially under the heads of cerebral and spinal 
hyperemia, convulsions and tetanus, which see. 

Auxiliary Treatment. — Prophylaxis. — Immediately after a 
person is bitten by a rabid animal the wounded part should 
be forcibly sucked, or, if favorably situated for the purpose, a 
cupping glass may be applied; then, instead of excising the 
wound, which endangers the infection of the freshly cut sur- 
face by virus from the blade of the instrument, the pure nitrate 
or chloride of silver, or other caustic, should be applied to every 
recess of the wounded part, so as to decompose the virus and 
destroy the vitality of the affected tissues. This plan is rec- 
ommended by Youatt, who was himself bitten several hun- 
dred times by rabid dogs without becoming infected after 
applying the caustic in this manner. He prefers the chloride 
of silver for the purpose, as being a more efficient caustic than 
the nitrate. If the patient can be induced to submit to it, and 
the case is a very suspicious one, it is safer to use the actual 
cautery, in the form of a white-hot iron. A poultice should 
then be applied until sloughing of the eschar occurs, after 
which, if deemed advisable, the wound may be kept discharg- 
ing, by any simple stimulating ointment, until the period of 
greatest danger is passed, or until it fills up with healthy 
granulations. 

Among other accessory measures which at different times 
have proved of greater or less benefit in these cases, the most 



152 NERVOUS THERAPEUTICS. 

efficient are the steam bath, ice to the spine, Faradization and 
galvanism. 

CHOREA. 

Synonyms. — St. Vitus's Dance, St. Guy's Dance, St. John's 
Dance, Chorea Sancti Viti, Chorea Minor; Fr., La Choree, 
Folie Musculaire, Danse de St. Guy, Danse de St. Witt; Ger., 
Veitstanz. 

Definition. — An affection of the nervous system, character- 
ized by a succession of uncoordinated movements of the volun- 
tary muscles, occurring almost exclusively in the waking state, 
in almost all parts of the body, and either entirely withdrawn 
from the sphere of volition, or but little under its control. 

Diagnosis. — Partial choreic movements, or local choreas, 
are apt to be mistaken for true chorea; they differ from the 
latter not only by being definite spasms located in one part — 
as, for example, twitchings on one side of the head or face — 
but in being usually incurable. Chorea bears some resem- 
blance to tremor, and especially to that form of it called pa- 
ralysis agitans, but these disordered movements are usually 
confined to adults and the aged, besides being more rhythmical 
and restricted. Chorea differs from hysteria by its proneness 
to attack children, and by the movements being little if any 
under the control of the will, while hysteria is mostly a disease 
of adult life, and is ameliorated rather than aggravated by 
voluntary exertion. Chorea magna is an entirely different 
affection from chorea minor, or what is commonly called 
chorea, consisting as it does of a series of complicated move- 
ments occurring at irregular intervals, and exactly simulating 
voluntary movements — such, for example, as taking three 
steps forward and then making a low bow, or rising from a 
chair, jumping over it, and then sitting down again as if 
nothing had happened — actions which result from an entirely 
uncontrollable impulse. These forms of so-called chorea have 
at times prevailed as regular epidemics (tarantismus), and par- 
take more of the hysterical nature than they do of true chorea. 

Pathology. — The fact that ninety-nine out of a hundred 
cases of chorea minor are curable, renders it almost certain 



CHOREA. 153 

that no serious lesion, such as minute emboli, softening, etc., 
exists in either of the great nerve-centres. It is true that in a 
few fatal cases post-mortem examination has revealed such 
changes, but these are the exception rather than the rule. 
Besides, fright is one of the most common causes of the disease, 
and surely fright is not capable of producing serious organic 
disease. I am therefore disposed to regard the choreas of 
childhood as functional neuroses, often associated with the 
rheumatic diathesis, or with cardiac disease depending upon 
it, together with an enfeebled state of the nervous system, the 
result of anaemia impairing the nutrition of the nerve-centres. 

Clinical Experience. — The remedies which have received 
the strongest indorsement of the profession in this disease are : 
My gale las., Agaricus mus., Oimicifuga, Causticum, Pulsatilla, Coc- 
culus, Nux vom., Ignatia, Hyoscyamus, Tarantula, Calcarea, Cup- 
rum, Zincum, Stramonium, Asterias rub., Sulphur, Veratrum vir. 
and Cina. 

Therapeutic Indications. — Mygale.— Muscles of the face 
jerk and twitch; eyelids and mouth open and close in rapid 
succession; in trying to put the hand to the mouth it is 
arrested midway and jerked down; gait unsteady; legs in 
motion while sitting, and dragged while attempting to walk ; 
constant motion of the whole body; indicated in all typical 
cases not especially calling for some other remedy. 

Agaricus. — Marked and frequent nictitation or twitching of 
the eyelids-; spasmodic movements, from simple involuntary 
motions and jerks of single muscles to a dancing of the whole 
body; trembling of the limbs; soreness of the spine; redness 
of the eyes; involuntary movements cease while asleep; symp- 
toms worse during a thunderstorm. 

Cimicifuga. — Mind greatly depressed; great nervousness; 
muscular twitchings resembling chorea, the left side being- 
most affected ; pain under the left breast; tenderness over the 
last cervical vertebra; tenderness over the ovarian regions; 
especially suited to cases occurring in young girls at or about 
the age of puberty, or when there are present symptoms indic- 
ative of menstrual disorder. 

Causticum. — Choreic movements even in the night; move- 
11 



154 NERVOUS THERAPEUTICS. 

ments involve the right side of the body more than they do 
the left; the muscles of the tongue are affected so that the 
speech is thick, and the words have to be jerked out; there is 
a marked paretic condition of the affected parts; especially 
indicated in rheumatic cases, or when resulting from cold or 
exposure. 

Pulsatilla. — Symptoms due to disease of the genital organs, 
such as amenorrhcea, dysmenorrhea, ovaralgia, etc.; choreic 
movements occurring in young girls at or near puberty. 

Cocculus. — Movements chiefly confined to the right side of 
the body, as the right arm or the right leg; menses dark and 
scanty; thin, scrawny girls, with irregular periods, and subject 
to venous or hemorrhoidal congestions; tendency to paralysis 
of the affected parts. 

Nux vom. — Numbness of the affected parts, also formication ; 
impaired appetite; constipation; vague flying pains about the 
chest and legs; movements renewed by the least touch, but 
diminished by strong and steady pressure; symptoms worse 
early in the morning; chronic cases, especially such as have 
been under old-school treatment. 

Ignatia. — Cases which have resulted from depressing emo- 
tions, such as grief, fright, etc. ; cases attended by sighing, sob- 
bing or a disposition to be alone ; most useful when the left 
side is affected ; worse after eating ; better when lying on the 
back. 

Hyoscyamus. — The twitchings, which are mostly local or con- 
fined to certain parts, as the face, the eyelids, the arm, etc., 
are especially violent and jerky; disposed to laugh and be 
talkative ; is extremely silly and agitated ; worse after eating, 
which is performed hastly. 

Tarantula. — Choreic movements general, or else crossed, as 
the right arm and left leg; head drawn downward ; involun- 
tary discharges of urine ; grimaces of the mouth ; is in con- 
stant motion ; can run better than walk ; trembling of the body ; 
movements continue even at night, but subside under the in- 
fluence of music. 

Calcarea carb. — Scrofulous habit, light hair, blue eyes, cold, 
damp feet ; involuntary movements often limited to one side 



CHOREA. 155 

of the body; apt to stumble or fall down; sore eyes; white 
stools ; bloated abdomen. 

Cuprum. — Legs and arms in perpetual motion, with constant 
motion of the muscles of the face; delicate constitution; face 
and tongue pallid; irregular movements commence in one 
limb and spread to other parts, sometimes involving the whole 
body, at others limited to only one side of it ; great mental 
exaltation ; better when lying down or when asleep, but never 
cease altogether. 

Zincum. — Chronic chorea, embracing all the voluntary muscles 
of the face, trunk and limbs, so that she was unable to eat,, 
walk or lie; had had all kinds of treatment, embracing chaly- 
beates and other tonics; general health greatly impaired. 

Stramonium. — Crossed, irregular movements of the voluntary 
muscles, as, for example, the right arm and left leg ; head and 
neck in constant motion ; patient leaps about, making the most 
grotesque gestures ; weeps, laughs, sings, prays, stammers and 
does many silly and unusual things ; handles the genital or- 
gans ; is violently agitated by unfounded fears ; not disposed 
to talk, or unable to do so ; the involuntary movements greatest 
when awake, but may continue when asleep. 

Asterias rub. — Trembling and jerking movements of all the 
limbs, rendering her unable to feed herself or to walk; fre- 
quent, clear, profuse micturition ; from fright and mental de- 
pression. 

Sulphur. — Chronic cases, and after suppressed eruptions ; in 
one case the patient was disposed to admire common objects, 
raving over them ; she was pale and poorly nourished ; had 
existed six months ; patient is apt to be irritable, peevish and 
obstinate. 

Veratrum vir. — Choreic movements approach the form of 
eclampsia, are very violent and continue during sleep ; waked 
up by a continual champing of the teeth ; lips covered with 
foaming saliva; inability to swallow; great sexual excitement. 

Ciua. — Violent twitching of the muscles, with scintillation of 
the eyes, which flash like those of a snake ; the choreic move- 
ments commence with a shriek ; tongue, larynx and oesoph- 
agus affected, causing a clucking sound, like that of water 
poured from a bottle; when caused by worms or onanism. 



156 NERVOUS THERAPEUTICS. 

Cicuta. — Twisting, jerking and distortion of the limbs, some- 
times accompanied by screams ; sudden rigidity of the limbs. 

Auxiliary Treatment. — Care should be taken to remove, 
as far as possible, all exciting causes of the disease, such as in- 
testinal worms, pernicious practices, irregular hours, over- 
stimulation of body and mind, etc. ; and as the disease is 
essentially one of nervous debility, we should aim to strengthen 
and build up the system by nutritious diet, pure air, sunshine, 
regular hours, freedom from excitement, and such other hy- 
gienic influences as the case in hand may require. Care should 
also be taken not to allow the patient to associate w T ith others 
similarly affected ; neither should the patient's mind be allowed 
to dwell upon the disease. Choreic patients should never be 
scolded, as they have very little, if any, control over their move- 
ments, and harsh words will do far more harm than good. 

Chorea arising from spinal irritation will be benefited by 
the treatment recommended for that disease, which see. Elec- 
tricity is highly lauded by some authorities. Benedict says 
that out of twenty cases that he treated with the constant 
current not one failed to recover ; others, however, have been 
less successful with it. Hysterical chorea requires the special 
treatment recommended for hysteria, which see. 

HYSTERIA. 

Synonyms. — Hysterics, Hysteric Fit, Vapors, Malum Hys- 
tericum; Fr., Hysterie, Maladie Imaginaire, Mai de Mere; Ger., 
Hysterie, Mutterbeschwerde. 

Definition. — A disordered state of the nervous system, tend- 
ing to chronicity, characterized by acute attacks of functional 
spasm and paralysis, anaesthesia and hyperesthesia, resulting 
from irritative impressions, sometimes mental and sometimes 
physical, acting on the emotional centres of the brain. 

Diagnosis. — The diagnosis of hysteria, multifarious as are 
its symptoms and manifestations, resolves itself simply into 
the detection, as such, of a purely emotional disease. This, as 
a general rule, is not difficult, provided the observer bears in 
mind that the phenomena are, in most cases, imperfect imita- 



HYSTERIA. 



157 



tions of real diseases. In nearly every case there is something 
either contradictory or exaggerated about them which betrays 
at once their real character. Occasionally, however, owing to 
the nature and gravity of the symptoms, it becomes necessary 
to distinguish carefully between a fit of hysteria and one of 
epilepsy, of hystero-epilepsy or of puerperal convulsions. The 
following table gives the differential diagnosis between hys- 
teria and epilepsy : 



Hysteria. 



Epilepsy. 



Loss of consciousness gradual and par- 
tial or apparent. 

Face flushed or unchanged, no froth on 
lips, eyelids closed, eyeballs fixed, 
no grinding of teeth or biting of 
tongue ; pupils react readily. 

Countenance not distorted. 

Sighs, laughs or sobs. 

Globus hystericus. 

Paroxysm longer than in epilepsy, 
usually wakeful and depressed in 
spirits. 

Rarely occurs at night. 

Often connected with uterine or men- 
strual disorders. 

Hystero-Epilepsy. 

Pressure upon the ovaries will fre- 
quently arrest the paroxysm. 

Thermometer never rises above 38.5° C. 



Sudden and complete. 

Livid face, froth at mouth, eyelids half 
open, globes rolling, teeth grind- 
ing, tongue bitten ; more or less 
insensibility of pupils to light. 

Countenance distorted. 

Shows no feeling. 

Aura epileptica. 

Short paroxysm, followed by heavy, 
comatose sleep and dull intellect. 

Frequently occurs at night. 

Xot necessarily connected with the 
uterus, though a paroxysm often 
occurs at the menstrual period. 

Will never modify or stop the attack. 

Thermometer always rises above 38.5° 
C, sometimes several degrees 
higher. 



Hysterical convulsions may be distinguished from puer- 
peral eclampsia, not only by the previous history of the case, 
but by the presence in the latter of complete unconsciousness 
and albuminuria. Hysterical paralysis may be distinguished 
from the various forms of cerebral and spinal paralysis by the 
symptoms peculiar to the latter. This will sometimes neces- 
sitate a continued watching of the hysterical disorder, which 
is usually more variable and more influenced by emotional 
excitement than the true disease. 



158 NERVOUS THERAPEUTICS. 

Pathology. — Although no constant pathological alterations 
have yet been discovered in either the brain or spinal cord, 
the symptoms show clearly that both of these great nerve- 
centres are involved in every well-developed case of the dis- 
ease. The psychical and emotional symptoms point unmis- 
takably to the brain as their origin, while various forms of 
spasms, paralysis and hemi-anaBsthesia can only be explained 
by referring the centre of diseased action to the same organ. 
In like manner the primary centre of reflex action can, in 
many cases, be traced directly to the spinal cord, the reflex 
action gradually spreading from the seat of irritation so as to 
involve adjacent groups of muscles under the control of that 
organ. That the peripheral nerves are not the primary seat 
of the hyperesthesia is shown by the fact that the symptom 
has continued to exist after the affected limbs have been 
amputated. These considerations, as well as others equally 
conclusive which might be adduced, prove that the cerebro- 
spinal centres are the parts especially involved in the irritation 
which disturbs the harmonious action of the various parts of 
the nervous system in this disease, but what the special condi- 
tion of these centres is. whether one of congestion, anaemia or 
some change analogous to that which gives rise to insanity or 
epilepsy, is as yet undetermined. 

Clinical Experience. — Ignatia amara comes so near to 
being a universal specific for hysteria that one seldom has 
occasion to resort to any other remedy. Gelsemium, Bella- 
donna, Aurum, Cimicifuga, Nux vom., Moschus. Sepia, Aconite, 
Lachesis, Chamomilla, Pulsatilla, Phosphorus, Valerian, Platina, 
Asafoetida, Stramonium and many other remedies have proved 
curative in particular cases. 

Therapeutic Indications. — These will be found under the 
several diseases simulated by the disorder, especially convul- 
sions, spinal irritation, paralysis and neuralgia, which see. 

Auxiliary Treatment. — Whatever may be one's opinion 
as to the essential nature of this disease, no one will deny that 
in the great majority of cases the mind exercises a controlling 
influence over it: it follows, therefore, that moral treatment 
is of paramount importance. Many cases have been cured by 



HYSTERO-EPILEPSY. 159 

one physician which had resisted the treatment of other prac- 
titioners equally competent, simply because the former, unlike 
the latter, had enlisted the patient's exertions in her own 
behalf. To do this the physician needs, first of all, to acquire 
the respect and confidence of his patient, after which he has 
only to direct and his directions will be obeyed ; but if, on the 
other hand, he fails in this regard, either through lack of tact 
or otherwise, his directions will most likely be ignored, if not 
entirely reversed. Besides, the co-operation of the patient is 
all the more necessary in order to successfully overcome the 
bad habits and banish the hurtful influences which are almost 
invariably associated with and tend to perpetuate the disease ; 
such as the various forms of dissipation connected with fash- 
ionable life, the use of stimulants, late hours, unwholesome 
reading, unsuitable occupations, the injudicious kindness of 
home friends, whose mistaken sympathy often leads them to 
foster rather than to counteract the natural inclinations and 
morbid desires of the patient. We have not the room to 
enlarge further upon this fruitful topic, but are free to say that 
unless the practitioner has the tact to overcome these difficul- 
ties his efforts to cure his patient will, nine times out of ten, 
result in utter failure. 

HYSTERO-EPILEPSY. 

Synonyms. — Epileptiform Hysteria; Ft., Hystero-Epilepsie ; 
Hysterie Epileptiforms; Ger., Hysteroepilepsie. 

Definition. — An unusually grave form of hysteria, the 
violence of the convulsions resembling that of epilepsy, and 
characterized by the most intense and remarkable forms of 
anaesthesia, paralysis and muscular contraction. 

Diagnosis. — Hystero-epilepsy differs from simple hysteria 
chiefly in the intensity of the symptoms, which give an epilep- 
tiform character to the paroxysms. It differs from pure epi- 
lepsy in never, even when of many years' duration, leading to 
dementia; the intellect always remains unimpaired. The epi- 
leptic group of symptoms is never complete, and never appears 
in connection with, or under the form of, the petit mat; it never 



160 NERVOUS THERAPEUTICS. 

assumes the form of vertigo-epileptique. Compression of the 
ovaries always modifies the attack, and sometimes completely 
arrests its effects, which results are never produced in true epi- 
lepsy. In hystero-epilepsy, even when the disease lasts a long 
time, the thermometer never rises above 38.5° C; while in true 
epilepsy, under similar circumstances, the thermometer rises 
much higher than this, even when the disease is not compli- 
cated with cerebral or meningeal congestion, in which latter 
case the temperature still continues to rise until it may indi- 
cate a fatal termination. 

Pathology. — As the same causes that give rise to hysteria 
operate to produce hystero-epilepsy in certain neurotic consti- 
tutions, the pathology of the disease is no doubt of the same 
general character; the only difference, so far as our present 
knowledge extends, is that the ovaries constitute the special 
primary centres of reflex irritation, whence originate the 
cerebral and spinal symptoms. The blood, also, may be more 
or less depraved, as in simple hysteria, but this point has not 
yet been definitely settled. 

Clinical Experience. — The remedies which have so far 
given the best results in hystero-epilepsy are: Cannabis ind., Ig- 
natia, Gelsemium, Amyl nit., Moschus, Tarantula and Hyoscyamus. 

Therapeutic Indications. — The same as in convulsions, 
spinal irritation, epilepsy and hysteria, which see. 

Auxiliary Treatment. — MM. Charcot and Bourneville 
have obtained curative results by the continuous application 
of the ice-bag compress over the ovarian region. Whenever 
there is an ovarian aura the breaking out of the fit can be 
prevented by it. 

Dr. Petit has treated the disease successfully by metallo- 
therapy. He gives Aurum chlor. internally, and places disks of 
gold on the limbs, causing in one case a complete cure, so that 
within a year after the commencement of treatment the patient 
married. In this case the left arm was contracted during two 
years, there w T ere general amyosthenia and ansesthenia, and the 
patient suffered intensely from ovarian pain, vomiting and 
spasmodic contractions of various muscles, including those of 
the oesophagus and vagina. 



CATALEPSY. 1G1 

CATALEPSY. 

Synonyms. — Morbus Attonitus, Carus Catalepsia, Hysteria 
Cataleptica; Fr., Catalepsie; Ger., Convulsivische Starrsucht 

Definition. — A peculiar form of nervous disease, allied to 
hysteria, occurring in paroxysms, and characterized by a loss, 
more or less complete, of consciousness, sensibility and volun- 
tary motion, during which the limbs are rigid and remain in 
the exact position in which they chanced to be at the moment 
of attack, or in that in which they are afterwards placed. 

Diagnosis. — The above definition is sufficiently precise to 
prevent the possibility of mistaking this disease for any other, 
unless it be some other hysteroid affection, such as ecstasy, 
hysteric unconsciousness, etc., a matter of no practical impor- 
tance, as these conditions are all of a similar nature and fre- 
quently pass from one into the other. 

Pathology. — As in hysteria there appears to be a partial 
loss or diminution of will power, so here the controlling power 
of the will appears to be completely lost; in other words, there 
is not only loss of consciousness and sensibility, but complete 
paralysis of the will. " My sensations," said one who had 
recovered, " were too feeble to call forth an exercise of will." 
That this is the true explanation is proved by the fact that 
the condition can be produced artificially. Charcot and others 
have shown that when thrown into the hypnotic state the 
cataleptic condition can at any moment be brought about by 
the mere suggestion that the subject no longer has any power 
to move his own limbs. 

Clinical Experience. — The only remedies I can find to 
which cures have been attributed are: Cannabis hid., Artemisia 
vulg. and Aranea diad. 

Therapeutic Indications. — Same as in hysteria, which see. 

Auxiliary Treatment. — According to Prof. Rosenthal, 
Faradization of the face by metallic conductors not only re- 
stored the consciousness, but brought about complete recovery 
from a cataleptic attack in a woman whose death had already 
been certified by a country practitioner. 



162 NERVOUS THERAPEUTICS. 

MULTIPLE CEREBROSPINAL SCLEROSIS. 

Synonyms. — Disseminated Cerebro-spinal Sclerosis; Fr., 
Sclerose en Plaques Disseminees ; Ger., Multiple Cerebro-spinale 
SJclerose. 

Definition. — A disease characterized by overgrowths of neu- 
roglia, in the form of plates or nodules, of varying size and 
shape, disseminated throughout the spinal cord, and also 
through different parts of the brain. 

Diagnosis. — The most characteristic mark of this form of 
sclerosis is the universal trembling which ensues on voluntary 
movements, and the fact that the trembling of the head, of 
the upper and lower extremities, as well as of the whole body, 
is considerably increased with every motion. Even the tongue 
trembles when the patient is requested to protrude it, while 
disturbances of speech are a constant characteristic clinical 
symptom. 

Pathology. — In describing other forms of sclerosis we have 
repeatedly stated that the essential morbid process consists in 
hypertrophy or proliferation of the neuroglia, at the expense 
of the proper nerve-tissue. In this form the sclerosed tissue 
appears, as above stated, in the form of plates or nodules in 
different parts of the brain and spinal cord. 

Treatment. — See the various forms of cerebral and spinal 
sclerosis, including locomotor ataxia, pp. 42, 102-107. 

SECONDARY CEREBRO-SPINAL SCLEROSIS. 

Synonyms. — Secondary Cerebro*spinal Degenerations, Sec- 
ondary Degenerations of the Spinal Cord, Ascending and 
Descending Degenerations; Fr., Degenerations Secondaires de la 
Moelle Epiniere ; Ger., Secondare Erkrankung Einzelner Riicken- 
marJcsstrdnge, Secondare Cerebro-spinale Skier ose. 

Definition. — Sclerotic degenerations affecting certain por- 
tions of the cerebro-spinal axis, resulting from trophic lesions 
situated either in the brain or spinal cord; if in the former 
they give rise to descending degenerations, if in the latter to 
ascending ones. 



GENERAL PARALYSIS. 163 

Diagnosis. — Secondary cerebrospinal sclerosis may be diag- 
nosed by the concurrent existence of the foot phenomenon, the 
tendon reflex and the phenomena of associated movements. 

Pathology. — The degenerative changes are usually confined 
to the white substance, and consist in atrophy and degeneration 
of nervous filaments, the formation of granular corpuscles and 
the characteristic proliferation of the neuroglia. When the 
gray matter is involved the nerve-cells undergo more or less 
disintegration and wasting; muscular atrophy is then asso- 
ciated with the rigidity and contraction resulting from de- 
generation of the white substance. 

Treatment. — Consult the various forms of cerebral and spinal 
sclerosis already given, especially locomotor ataxia, pp. 42, 102- 
107. 

GENERAL PARALYSIS. 

Synonyms. — General Paresis, Paralysis of the Insane, De- 
mentia Paralytica; Fr., Paralysie Generate Incomplete, Perien- 
cephalite Chro'nique Diffuse ; Ger., Allgemeine Progressive Gehirn- 
lahmung, Paralytischer Blbdsinn. 

Definition. — A general paretic condition, accompanied by 
gradually increasing mental disturbance, incoordination of 
movement and loss of physical power. 

Diagnosis. — The diagnosis is based upon the presence of 
convulsive tremors in the muscles of articulation at the com- 
mencement of the disease, the general and progressive paresis 
and loss of coordination, and the peculiar mental manifestations 
of aberration and extravagance. 

Pathology. — There are usually more or less congestion and 
inflammatory thickening of the cerebral membranes, atrophy 
and degeneration of the cortical substance, especially of the 
anterior lobes, and wasting and amyloid degeneration of the 
ganglion cells, with hypertrophy of the neuroglia. Similar 
changes also occur in the posterior columns of the spinal cord, 
the cerebral nerves and the posterior roots of the spinal nerves. 

In some cases there are signs of granular myelitis; large 
masses of fat globules, with hypertrophy of the septa of the 
cord. It thus appears that the disease is a diffuse inflamma- 



164 NERVOUS THERAPEUTICS. 

tion of the brain and spinal cord, leading finally to destruction 
of ganglion cells and atrophy of the nerve-centres. 

Clinical Experience. — Argentum nit. and Plumbum are 
entitled to the distinction of having arrested the degenerative 
process. Belladonna, Physostigma, Cocculus ind., Badiaga, Oxalic 
ac, Causticum, Gelsemium, Rhus tox., Phosphorus and a number 
of other remedies have ameliorated many of the symptoms. 

Treatment. — See meningitis, encephalitis and the several 
forms of paralysis and sclerosis already described, especially 
locomotor ataxia. 

PARALYSIS AGITANS. 

Synonyms. — Shaking Palsy; Fr., Paralysie Agitante, Para- 
lysie Tremblante; Ger., Schiittelldhmung. 

Definition. — A disease of the nervous system, characterized 
by tremor of the voluntary muscles, followed by paralysis of the 
same, both being progressive in their course. 

Diagnosis. — Paralysis agitans is liable to be mistaken for 
chorea, senile tremor and multiple sclerosis. From the first it 
may be distinguished by the age of the patient and the history 
of the case; from tremor senilis, from being a disease of middle 
life instead of old age, and by its beginning on the head 
and attacking successively the lips, tongue and extremities; 
and from multiple sclerosis, by the latter being a disease of 
youth, and the tremor appearing only when motions are 
intended, whereas, in paralysis agitans, the tremor, though it 
may be increased from an intention to motion, or from mental 
excitement, is also observed during perfect rest. 

Very rarely a case is seen, and it may even run its course, 
without any tremor being present. In these cases the disease 
is recognized by the other characteristic symptoms, such as 
fixed attitude, slow, delayed movements, difficulty in rising 
from the sitting posture, retropulsion, apropulsion, monotonous 
and mumbling speech, etc. 

Pathology. — No characteristic pathological changes have 
yet been observed sufficient to account for the symptoms of 
this disease. Various coarse lesions have not infrequently 
been met with in both the brain and spinal cord, but those 



PARALYSIS AGITANS. 165 

hitherto observed have been such only as are frequently pres- 
ent in those who die of old age where no such symptoms are 
present. Although in many cases, however, the results have 
been negative, the fact that some observers have found sclerosis 
in various parts of the brain and spinal cord renders it highly 
probable, I think, that a certain degree of hypertrophy of the 
neuroglia constitutes the essential element of the disease. 

Clinical Experience. — I can find none of our remedies to 
which cures of this disease have been attributed except Plum- 
bum, Mercurius and Tarantula. Good results, however, have 
followed the administration of Argentum nit, Baryta carb., 
Hyoscyamus, Physostigma and Zincum. 

Treatment. — Compare the various sections devoted to pa- 
ralysis and sclerosis, especially multiple cerebral and posterior 
spinal sclerosis, pp. 42, 107. 



PART IV. 

DISEASES OF THE PERIPHERAL NERVOUS SYSTEM. 



NEURITIS. 

Synonyms. — Inflammation of a Nerve; Fr., Nevrite; Ger., 
Entzundung der Nerven, Nerventzundung. 

Diagnosis. — The pain does not intermit as in neuralgia, 
neither is it excessive, except in traumatic acute neuritis. The 
disease may also be distinguished from neuralgia by the in- 
creased temperature of the part to which the nerve is distrib- 
uted, and by the history of the case. Anaesthesia, spasm and 
paralysis, which are common symptoms of neuritis, are absent 
in neuralgia. From cerebro-spinal diseases, in which these 
symptoms are present, it may be known by the circumscribed 
limits of the disease and by the absence of central symptoms. 

Pathology. — The pathological changes are chiefly confined 
to the neurilemma or connective-tissue sheath of the nerve, 
which is found to be more or less injected and hypersemic. 
Microscopical examination reveals, in addition to the increased 
vascularity, inflammatory proliferation of new tissue-elements 
with migrated leucocytes. These changes necessarily produce 
either irritation, or arrest or disturbance of nerve function, 
through compression of the nerve tubules by swelling of the 
nerve-sheath. 

Clinical Experience. — Aconite, Belladonna and Hypericum 
have proved curative in the early stages of acute cases ; trau- 
matic cases usually yield promply to the internal and external 
use of Hypericum perf. and Calendula. 

Auxiliary Treatment. — The wet compress, hot fomenta- 
tions and ice, locally applied, all have their advocates in this 
disease. The new operation of nerve-stretching may be of 
benefit in chronic cases. 

(166) 



NEURALGIA. 107 

NEURALGIA. 

(In General.) 

Synonyms. — Nervous Pain, Neurodynia; Fr., Nevralgie; 
Ger., Neuralgic. 

Definition. — A functional disease of the nerves, almost 
always unilateral, usually confined to the origin, course or 
termination of one or more nervous trunks or branches, and 
unaccompanied by fever, inflammation or any appreciable 
organic lesion. 

Diagnosis. — The diagnosis of neuralgia is not usually at- 
tended with any difficulty. When the pain takes the course 
of a nerve we know at once that it is neuralgic, but when it 
is confined to an organ, space or spot, other circumstances have 
to be considered : (1) the pain is always more or less paroxys- 
mal; (2) it usually begins suddenly, is of a darting, lancinating 
or boring character, and is confined to the course of the nerve 
and its several branches ; (3) the paroxysm develops sponta- 
neously or without any marked exciting cause ; (4) puncta do- 
lorosa are observed in the majority of cases somewhere in the 
course of the nerve ; and (5) vaso-motory, trophic and other 
disorders are occasionally associated with it. 

Pathology. — The disease, per se, is a purely functional 
affection, but many cases occur in which there is reason to 
think that inflammation of the nerve-sheath is the starting 
point and proximate cause of the disease. This is often the 
case in sciatica, which is more frequently, perhaps, a peri- 
neuritis than a pure neuralgia. In these cases the pain is 
much more constant, that is, less parox}^smal than usual, and 
is more apt to be attended by paretic symptoms. 

Clinical Experience. — In order to avoid undue repetition, 
we shall defer giving the usual therapeutic indications until 
w r e come to consider more in detail the leading varieties of the 
disease, substituting here a general resume of clinical ex- 
perience. 

Spigelia. — Sharp and cutting pains, extending over the tem- 
ples and forehead, with profuse flow of water from the eyes; sharp 
pain in the left side of the face and head, with intense pain in 
the eyeball. 



168 NERVOUS THERAPEUTICS. 

Ammonium pier. — Violent boring pain in the right side of trie 
head, spreading to the supraorbital and superior maxillary 
region, intermittent, commencing at 10 a.m., increasing till 
2 p.m., and disappearing about 9 p.m. 

Hamamelis. — Xeuralgia of the internal saphenal nerve in the 
ascending form; severe pain on the internal side of the right 
knee, radiating from the internal condyle of the femur to the 
crural arch; lancinating and burning pains piercing the knee 
and extending to the groin. 

Magnesia plios. — Typical facial neuralgias; pains intermittent, 
darting, lightning-like, suddenly appearing and disappearing, 
relieved by heat and pressure. 

Kalmia. — Neuralgia facialis, nocturnal; sharp, shooting and 
twitching pains, commencing in the neck, going to the top of 
the head, then to the temples and right side of the face; re- 
lieved by cold, aggravated by heat. 

Pulsatilla. — Right side of head and face; worse at night, with 
throbbing in the head; face flushed; external soreness; always 
occur when nursing. 

Aconite. — Congestive forms of trifacial neuralgia: pains lan- 
cinating and burning; great agitation. 

Arsenicum. — Neuralgia of the fifth nerve, acute; violent attacks 
of tearing, burning pain, occurring every five minutes both 
day and night, in the second branch of the trigeminus, chronic ; 
lu m bo-abdom inal neu ralgia. 

Rhododendron. — Violent prosopalgia, spreading over the right 
side of the face from the teeth, and radiating over the mouth, 
eyes and ears, equally violent da}' and night; pains drawing, 
tearing, jerking; ameliorated by warmth, when eating, and for 
some time afterward. 

Mezereum. — Dull, gnawing, sometimes severe boring pain all 
along the jaws and gums; cutting, shooting pain, returning 
every night on the left side, extending from the face to the ear, 
temple and neck, worse when warm in bed; severe supra- 
orbital, intermittent, circumscribed, diurnal pain, beginning 
at 9 a.m., increasing until noon, subsiding about 4 p.m., of a 
heavy, aching character, sometimes extending into the left eye, 
causing a flow of tears. 



NEURALGIA. 169 

Lachesis. — Dull, heavy, severe pain, commencing at 9 a.m. in 
the inner canthus of the right eye and extending outward and 
'upward above the superciliary ridge, going off in the afternoon ; 
skin extremely sensitive to touch; worse after sleeping. 

Tartar emet— Severe neuralgic pains in the right leg, follow- 
ing the sciatic nerve, pain running from above downward; 
muscles of the leg felt tense. 

Bryonia. — Trigeminal neuralgia of the left side; pain acute, 
the motion necessary to speak or eat aggravated it to such an 
extent as to provoke a free flow of tears; severe pain in the 
right side of the head, face and jaws, worse in the morning, 
occurring during pregnancy. 

Grelsemium. — Severe orbital neuralgia, occurring frequently, 
and accompanied by heaviness and drooping of the upper eye- 
lids and great muscular weakness; severe paroxysms of right 
facial neuralgia, lasting six months; neuralgia of the anterior 
crural nerve, pain extending up to the iliac crest and down to 
the inner side of the knee, accompanied by tenderness between 
these points. 

Iris ver. — Trifacial neuralgia in the left temporal region, ex- 
tending down the ramus of the lower jaw into the teeth, pain 
sharp and cutting. 

Veratrum alb. — Neuralgia palpebrares of the right upper lid, 
greatly aggravated by pressure, the most delicate touch feeling 
as if hundreds of needle points were penetrating the cuticle of 
the lid; colic-like pains, followed by diarrhoea. 

Sabina. — Facial neuralgia depending on paramenia; general* 
neuralgia, occurring one week prior to menstruation, accom- 
panied by frequent shudderings, burning heat in the whole 
body and great nervous irritability. 

Bismuthum. — Severe facial neuralgia; pains burning, and 
greatly aggravated by warmth; relieved by holding cold water 
in the mouth. 

Natram mur. — Facial neuralgia of malarial origin ; pains begin 
about 8 p.m. in the region of the right eye, the right side of 
the nose and the right frontal region, accompanied by high 
fever, great thirst and some nausea, subsiding with the abate- 
ment of the fever, and returning again the next evening. 

12 



170 NERVOUS THERAPEUTICS. 

Zincum phos. — General neuralgia depending on nervous de- 
bility; neurotic constitution; loss of memory; loss of sleep 
from continued mental anxiety. 

Kali cyan. — Left supraorbital neuralgia, beginning daily at 
9 a.m., reaching its height in less than an hour, and gradually 
declining just before noon, the decline being accompanied with 
considerable nasal discharge. 

Aranea diad. — Lumbo-abdominal neuralgia of a remittent 
character, exacerbation occurring between 8 and 11 a.m., and 
continuing until evening, attended at its height by excessive 
yawning, and at times by vomiting. 

Plumbum met. — Neuralgia of the rectum ; pain of a drawing, 
gnawing character, worse toward evening and at night. 

Kali bich. — Infraorbital neuralgia; pain aggravated by mo- 
tion, and especially by cold. 

Conium. — Infraorbital neuralgia; tearing, cramplike pains, 
occurring in the evening and at night ; mastodynia. 

Nux vom. — Supraorbital neuralgia of an intermittent char- 
acter; sudden, agonizing, lightning-like pains, coming on in 
the morning and aggravated by pressure and motion. 

Colchicum. — Facial neuralgia, involving especially the infra- 
orbital nerve ; pains of a tearing character, and accompanied 
with trembling and twitching of the lips and muscles of the 
face. 

Auxiliary Treatment. — Special attention should be given 
to nutrition, especially in obstinate cases. Romberg's theory 
that " neuralgia is the prayer of the suffering nerve for healthy 
blood and more of it," has been abundantly verified. Hence 
patients suffering from debility (and nearly every such patient 
is more or less debilitated), scrofula, tuberculosis, or any other 
dyscrasic condition, should push the nutritive process to the 
utmost. One of Pretz's patients ate twelve times in twenty- 
four hours and improved under it. Tuberculous cases are 
usually benefited by a course of cod-liver oil. Phenacetine and 
other analgesic palliatives may prove more or less useful in 
obstinate cases. 

Electricity, nerve-stretching, compression, sea-bathing, hot 
fomentations and the local application of Aconite, Menthol 



TRIGEMINAL NEURALGIA. 171 

and other stimulating and rubefacient applications have all 
done good in special cases. Gussenbauer ascertained that the 
great majority of trifacial neuralgias are due to reflex irritation. 
While some cases follow from sexual disease, malaria, tobacco 
poisoning, etc., ninety per cent, of trigeminal neuralgias result, 
he says, from habitual constipation, and may be treated suc- 
cessfully by cold water enemata and hydrotherapy. 

TRIGEMINAL NEURALGIA. 

Synonyms. — Neuralgia of the Fifth Nerve, Facial Neu- 
ralgia, Prosopalgia, Neuralgia Trigemini; Fr., Tic- Douloureux ; 
Ger., Neuralgie des Funftenerven } Neuralgie der Trigeminus. 

Definition. — Neuralgia of one or more branches of the tri- 
facial or fifth nerve. 

Diagnosis. — Trigeminal neuralgia is most likely to be con- 
founded with hemicrania. It may be readily distinguished 
from it, however, by the transient and shooting character of the 
pains and by their corresponding with the course and distri- 
bution of the different branches of the nerve. It is important, 
also, to distinguish trigeminal neuralgia from odontalgia, as 
many a sound set of teeth have been needlessly sacrificed to 
cure a supposed neuralgia which did not exist. In toothache 
the pain is usually continuous, or it is made worse when some 
of the teeth are subjected to pressure or to cold, and if closely 
examined defective places may be found in them. 

Pathology. — The most diligent search has often failed to 
find anything abnormal about the trunk of the nerve or any 
of its branches. It is quite certain, however, that the sym- 
pathetic nerve is sometimes implicated in the attacks, for in 
no other way can we explain such symptoms as contraction of 
the pupils, conjunctival injection, flushing of the face and the 
constitutional disturbances sometimes met with ; but it is not 
always certain whether these phenomena originate in the sym- 
pathetic system or are secondary to the trigeminal disease. 

Clinical Experience. — See the preceding section. 

Therapeutic Indications. — Arsenicum. — Severe burning 
pains, as if made with hot needles; pains appear toward night 



172 NERVOUS THERAPEUTICS. 

and reach their greatest intensity near midnight; the anguish 
is sometimes so great as to compel the patient to get up and 
walk about; aggravated by noise and motion, also by cold 
water, which at first relieves ; ameliorated by hot applications. 

Mezereum. — Pains appear suddenly on moving the jaws, espe- 
cially on eating hot things; stiffness of the muscles of the neck ; 
aggravated by the lightest touch, but diminished by hard press- 
ure; may affect any or all three of the trifacial branches. 

Kali carb. — Burning pains, with twitching of the muscles, affect- 
ing preferably the mental and infraorbital branches ; pains 
accompanied by beating of the temporal arteries ; aggravated 
by eating sour fruit or by mental excitement. 

Nux vom. — Lightning-like pains, with twitchings of the 
affected parts; violent, agonizing pains, obliging the patient 
to change his position frequently or to walk about ; pains 
sometimes diminish on remaining quiet or on lying down. 

Cuprum. — Lightning pains, with violent throbbing of the 
temporal arteries and great anguish; pains aggravated by 
touch. 

Thuja. — Acute shooting pains throughout the course of the 
infraorbital nerve, producing flashes of heat in the face and a 
sensation of internal heat; cramping pains, with muscular 
twitchings ; convidsive movements of the upper lip accompany the 
exacerbations of pain ; ameliorated b} r motion and by the open 
air. 

Bryonia. — Severe aching and shooting pains, which may ex- 
tend to the ear, involving especially the left inferior dental 
branch; teeth and gums sore; sometimes, but not always, re- 
lieved by warmth ; aggravated by chewing and by cold. 

Ignatia. — Violent, agonizing pains, affecting especially the 
supraorbital nerve, occurring in sudden, short jerks, diminish- 
ing or disappearing on moving the affected part, but immediately 
returning ; usually aggravated by pressure. 

Aconite. — Lancinating and burning pains, accompanied by 
painful tingling and prickling, redness of the affected parts 
and restlessness; pains sometimes relieved by strong friction, but 
aggravated by motion. 

Phosphorus. — Lancinating, lightning-like pains, affecting 



TRIGEMINAL NEURALGIA. 173 

chiefly the infraorbital nerve, and accompanied by twitchings 
in the affected part ; pains excited by the least movement of 
the part, especially by mastication, so much so as to cause the 
patient to refrain from eating or drinking. 

Spigelia. — Pains extend to the eyes, which are more or less 
injected, and seem to be compressed in the orbit; pains aggra- 
vated by the slightest touch or movement. 

Zincum. — Lightning pains, with mnscular twitchings, affect- 
ing any or all three branches; eyes appear sunken, eyelids 
bluish, face pale, tongue congested ; pain increased by pressure. 

Argentum nit. — Pains of a sudden, rending character, extend- 
ing into the orbit ; globe feels as if it would be pressed out ; 
face pale, sight impaired, affected parts somewhat anaesthetic. 

Belladonna. — Cutting, throbbing pains, frequently extending 
into the eye and temple, or into the ear; affecting especially 
the right side of the face ; worse in the afternoon and evening; 
aggravated by motion, light and noise. 

Sepia. — Drawing, tearing pains, extending to the teeth, ver- 
tex and occiput, worse in the left side and at night ; pains fre- 
quently extend to the ear ; aggravated or renewed by either 
warmth or cold; suited to delicate, sensitive women, especially 
when caused by cold, or when the menstrual function is dis- 
turbed. 

The following remedies may also be indicated : Coffea, 
Glonoin, Causticum, Stannum, Colocynthis, Verbascum, Chamo- 
milla, Chininum sulph., Cimicifuga, Graphites, Rhus tox. and Lyco- 
podium. 

Auxiliary Treatment. — Galvanic electricity is frequently of 
gr.eat benefit during the paroxysm, often relieving the most 
intense suffering at one sitting. The best mode of applying it 
is to place the wet sponge of the positive pole over the affected 
nerve, and that of the negative at any convenient point out- 
side the painful area. The current, which should be weak at 
first, will be most effective by being gradually increased until 
a slight sensation of heat is produced. One or two applica- 
tions a day, of not over ten minutes each, will be sufficient, ex- 
cept in chronic cases. 

Nerve-stretching has been practiced successfully in a number 



174 NERVOUS THERAPEUTICS. 

of instances, especially in the case of the supraorbital nerve, 
sufficient force being applied to liberate the nerve from any 
inflammatory or other form of compression, which may have 
interfered with its normal function. 

There is no better local application in these cases than a 
solution of Aconitia, one grain to the ounce, which may be 
painted over the painful nerve with a camel's hair brush when- 
ever required ; or the strong tincture of Aconite may be rubbed 
in along the course of the nerve until the part becomes numb, 
repeating the process pro re nata. 

MASTODYNIA. 

Synonyms. — Neuralgia of the Mammse, Mastalgia; Fr., 
Nevralgie des Mamelles ; Ger., Neuralgie der Brustdrilsen. 

Definition.— Neuralgia and hyperesthesia of the mammary 
glands. 

Diagnosis. — The disease is often confounded with inter- 
costal neuralgia, which is but one of its various forms. Some- 
times the slightest touch causes pain (hypersesthesia) ; at others, 
the deeper structures are involved, and the affection partakes 
more of a neuralgic character. 

Pathology. — The pathology of mastodynia is obscure. 
Sometimes small points on the glands are sensitive to pressure, 
due, probably, to enlargement of nerve-fibres. In other cases 
the affection appears to be seated in the dorsal region of the 
spine, from which the nerves supplying the mammary glands 
are derived. The constitutional conditions which give rise to 
it are, in the main, similar to those which favor neuralgia in 
other parts, namely, anaemia, chlorosis, hysteria, etc. Its 
relation to the sexual sphere is shown by its frequent associa- 
tion with disturbance of the sexual organism, especially at the 
menstrual period. 

Clinical Experience. — Phytolacca. — When complicated with 
hyperemia of the mammae ; the breasts are swollen and very 
sensitive to pressure, cannot bear to have them touched; 
neuralgic pain in the left ovary ; worse during menstruation 
and lactation. 



C6CCYG0DYXIA. 175 

Bryonia. — When every movement of the arm causes pain in 
the corresponding mamma; also when complicated with 
ovaritis. 

Arsenicum. — Periodical attacks, especially when complicated 
with malaria ; also when the pain is relieved by heat and 
aggravated by cold. 

Rhus tox. — Congestion of the mammas ; the breasts feel hot 
and dry ; the glands are swollen, and the pain is deep-seated, 
of an aching character and relieved by manipulation. 

Pulsatilla. — When associated with menstrual derangement, 
or when there is a constant feeling of chilliness. 

Aconite. — Cutaneous hyperaesthesia ; great restlessness and 
irritation, especially in young girls. 

Chamomilla. — Breasts hard and painful to the touch ; hot 
perspiration under the mammae. 

Cimicifuga. — Prickling sensations in the mammae ; when 
associated with characteristic menstrual symptoms, or with 
pain in the head and back. 

Compare, also, Conium, Calcarea carb., Kali carb., Nitric ac, 
Caladium, Murex. 

Auxiliary Treatment. — Fomentations, especially when 
medicated with the indicated remedy, are of great value in 
relieving the paroxysms of pain. Inunction of the breast with 
oil and quinine is said to be beneficial when the neuralgia 
alternates with neuralgia of other parts. It is also recom- 
mended to spray the mammae with cold water two or three 
times a day, employing friction afterward until the surface is 
brought to a glow. 

COCCYGODYNIA. 

Synonyms. — Xeuralgia of the Coccyx, Coccyodynia, Coccy- 
dynia; Fr., Douleur de Coccyx ; Ger., Kreuzendschmerz. 

Definition. — Pain, apparently of a neuralgic character, in 
the vicinity of the coccyx. 

Diagnosis. — As the disease is almost exclusively confined 
to women, and sometimes occurs after difficult parturition, it 
is liable to be mistaken for hysteralgia. It may be distin- 
guished from the latter by the fact that the patient cannot 



176 NERVOUS THERAPEUTICS. 

bear the least pressure on the os coccygis, whereas in hysteralgia 
the favorite position is one that throws the entire weight of 
the body on this very part. 

Pathology. — The disease is sometimes due to neuralgia of 
the coccygeal plexus, but this is not always the case. On the 
contrary, there is reason to believe that it is sometimes of a 
rheumatic and sometimes of an inflammatory nature. 

Clinical Experience. — The remedies which have been 
most frequently prescribed for this affection are: Cicuta, 
Acidum fluor., Ruta, Zincum, Rhus rad., Thuja, Conium and 
Carbo an. 

Therapeutic Indications. — Cicuta. — Tearing, jerking pains 
in the coccyx; stiffness in the lower limbs; when resulting 
from injury or pressure during confinement. 

Acidum fluor. — Periodical aching in the coccygeal region; 
aching pain in the os sacrum and lumbar region, relieved by 
pressure, stretching and bending backward, especially the 
former. 

Ruta. — Pain extending from the coccyx to the sacrum, as if 
caused by a blow or bruise. 

Zincum. — Aching, pinching and lancinating pains in the 
coccygeal and sacral regions ; pressure, tension and weakness 
in the sacral and lumbar regions ; back cracks when walking. 

Rhus rad. — Pain in the loins and lower spinal region, espe- 
cially when moving the hips or when lying in bed at night ; 
rheumatic cases, attended with a sense of weariness and lan- 
guor, with stiffness. 

Tarantula. — Burning, smarting and painful uneasiness in the 
coccyx after confinement, better when standing, worse from 
slightest pressure or motion. 

Thuja. — Painful drawing sensation in the coccygeal and sac- 
ral regions and in the thighs, when sitting ; sudden cramping 
pain in the lumbar region after long standing, and when at- 
tempting to walk it seems as though he would fall; after being 
seated awhile the drawing becomes so great as to hinder stand- 
ing erect. 

Conium. — Drawing and stitching pains in the lumbar, sacral 
and coccygeal region, followed by great weakness and nausea; 
drawing through the lumbar vertebrae when standing. 



SCIATICA. 177 

Carbo an. — Pain in the coccyx, which burns when the parts 
are touched ; pain as from subcutaneous ulceration, worse on 
sitting or lying down ; pressing, bearing-down pain in the 
coccyx, as if bruised. 

Consult, also, Silicea, Belladonna, Rhus tox., Causticum, Oistus 
can., Graphites, Paris quad., Kreosotum, Caniharidis, Petrolium, 
Magnesia, Phosphorus, Lachesis, Muriatic ac. and Cannabis sat. 

Auxiliary Treatment. — Extirpation of the coccyx has been 
resorted to in very obstinate and painful cases, also subcuta- 
neous section of the attached muscles and ligaments. Such ex- 
treme measures, however, are seldom necessary, as the homceo- 
pathically indicated remedy, aided, if necessary, by electricity, 
will cure the most rebellious cases. We have the testimony 
of Rosenthal that electricity alone cured a case of twelve years' 
standing. 

SCIATICA. 

Synonyms. — Ischias, Femero-popliteal Neuralgia ; Fr., 
Nevralgie Sciatique; Ger., Hiiftiveh. 

Definition. — Neuralgia of the parts supplied by the great 
sciatic nerve and its posterior cutaneous branches. 

Diagnosis. — Sciatic neuralgia is liable to be mistaken for 
rheumatism and for inflammation seated in and about the hip- 
joint. In the former case the pain is not spontaneous as in 
sciatica, but is always dependent on muscular action. Hip- 
joint disease is common in childhood and youth, while sciatica 
is seldom noticed under thirty years of age. But a slowly- 
developed chronic inflammation, usually called chronic rheu- 
matism, occurring in elderly people, is what is most frequently 
miscalled sciatica. If the pain is not increased by pressing 
the surfaces of the joint together, or by gently rotating the 
limb, it may be, and probably is, sciatica ; but it cannot be 
hip-joint disease. On the contrary, if the pain is made worse 
by this procedure, if there is great stiffness about the joint, so 
that the lower part of the body moves when an attempt is 
made to bend the hip-joint, and especially if the muscles in 
the vicinity of the joint are permanently contracted, then it is 
not sciatica, but an inflammation of the joint itself. 



178 NERVOUS THERAPEUTICS. 

Pathology.— There is little doubt that very many cases of 
sciatic neuralgia are due to rheumatic inflammation of the 
nerve-sheath, yet it has often happened that in cases which 
during life have been supposed to be examples of this affec- 
tion no trace of neuritis has been discovered. Be this as it 
may, sciatica, like every other form of neuralgia, is almost in- 
variably associated with a depressed state of the system, and 
this, as before stated, has led to the general belief that the nerv- 
ous system is not duly nourished. The correctness of this 
opinion would seem to be verified by the fact that a rich, 
nutritious diet, especially one rich in fats, always proves bene- 
ficial to the patient. I have an old chronic case now under 
treatment in a lady who remains entirely free from suffering 
so long as she continues to take cod-liver oil, but whenever she 
suspends the use of it for a few weeks the disease always re- 
turns with great violence. 

Clinical Experience. — See preceding section on neuralgia 
in general, pp. 167-171. 

Therapeutic Indications. — Nux vom. — Short, tearing and 
jerking pains, with trembling of the affected parts; stiffness 
of the affected limb, with sensation of paralysis ; can lie best 
on the sound side ; sometimes the pains diminish on lying 
down and keeping quiet, also after midnight; although the 
pains are aggravated by touch and by motion, they oblige the 
patient to move the affected part continually. 

Colocynthis. — Lightning-like pains in the course of either 
sciatic nerve, but especially the left; aggravated by touch, 
motion, pressure or cold, also worse at night or when warm in 
bed, but ameliorated during the day by warm applications ; 
pains accompanied by a sense of constriction ; especially suited 
to acute cases occurring in the young. 

Rhus tox. — Burning and tearing pains, attended by numb- 
ness, formication, sensation of cold and paralytic stiffness of 
the affected limb ; pains aggravated by rest, especially rest in 
bed and at the beginning of motion, but ameliorated by the con- 
tinuance of motion; has also cured cases aggravated by pro- 
longed motion. 

Bryonia. — Twitching pains extending from the lumbar region 



SCIATICA. 179 

to the thigh, with sweating; pains attended with shocks in the 
affected limb ; pains aggravated by touch and motion, but 
often ameliorated by hard pressure or by lying on the affected 
part, also by cold water; is suited to both acute and chronic 
cases, even when there is atrophy of diseased limb. 

Chamomilla. — Tearing, boring pains, occurring in young and 
nervous persons, especially w T hen the pain is worse at night and 
is accompanied by a sensation of paralytic weakness; great 
irritability of mind and temper. 

Plumbum. — Constant drawing and lancinating pains, in- 
creased by motion, heat and sudden pressure, but ameliorated 
by steady pressure; pains always worse at night, suited especially 
to chronic cases, or when there is a tendency to atrophy and 
paralysis. 

Arsenicum. — Tearing and burning pains, w T ith nightly aggrava- 
tions ; ameliorated by warm applications or by rubbing the 
affected part ; aggravated by touch and motion ; sometimes 
relieved by motion, especially at night, when the patient has 
to get up and walk the floor for relief; cannot lie on the affected 
side, and is very restless even on the sound side; is suited to 
both acute and chronic cases, especially when there is marked 
periodicity in their recurrence or aggravation. 

Ignatia. — Throbbing, intermitting pains, with fever, preceded 
by chilliness, with thirst; paroxysms at first tertian, afterward 
quotidian ; chronic cases, better in summer, worse in winter ; 
suited also to acute cases where the patient is obliged to con- 
stantly change his position to relieve the pain. 

Belladonna. — Severe lancinating pains, coming on in the 
afternoon or evening, or else worse from noon till midnight ; 
aggravated by the lightest touch, but frequently relieved by 
steady pressure; worse from motion or mental excitement; 
better from warmth, after perspiring, when erect, or when 
letting the limb hang down. 

Kali iod. — Pain in the hip, causing the patient to limp; 
nightly tearing pains in the right limb, aggravated by tying 
on the affected side ; muscles of the affected limb spasmodi- 
cally contracted: pains ameliorated by motion; chronic cases, 
with nocturnal aggravation, or when caused by mercury or 
syphilis. 



180 NERVOUS THERAPEUTICS. 

Mercurius. — Nocturnal pains in the course of the sciatic nerve, 
attended by nocturnal aggravation, chills, numbness, formication 
and tendency to sweat, the perspiration giving no relief; 
patient restless and constantly changing his position ; syphilitic 
cases. . 

Valerian. — Pains so intense that it seems as though the thigh 
would break; unendurable when at rest, or when sitting or 
standing, but relieved by walking about. 

Compare, also, the following remedies : Terebinthina, Lycopo- 
dium, Veratrum alb., Sepia, Ferrum, Tellurium, Nitric ac, Thuja, 
Ranunculus, Ledum, Gnaphalium, Argentum nit., Calcarea carb. y 
Coffea, Hepar sulph., Kali bich., Arnica, Gimicifuga, Iris vers., 
Cdusticum, Lachesis, Phytolacca, Gelsemium, Ruta, Stillingia, Men- 
yanthes, Pulsatilla, Polygonium, Natrum mur., Natrum salic. and 
Mezereum. For indications see the two preceding sections. 

Auxiliary Treatment. — In addition to the accessory treat- 
ment given in the last two preceding sections (which see), we 
add the following: As regards electricity, a strong galvanic 
current will generally relieve, those cases in which firm press- 
ure over the affected part causes no pain ; but where there is 
so much sensitiveness that slight pressure produces pain, strong 
galvanic currents usually do more harm than good. On the 
other hand, those cases which are aggravated or unrelieved by 
the galvanic current are almost always benefited by the Far- 
adic or induced current, or by the static current. 

Hypodermic injections of ether have cured some cases of 
sciatica, three drops of ether being injected at intervals of 
twelve hours. Debove claims to have succeeded in all his 
cases, both acute and chronic, by applying along the track of 
the nerve a spray of methyl-chloride, the degree of cold thus 
produced being as low as 22° ; the line of congelation soon 
becomes red and warm, erythema and blisters usually develop- 
ing, but a true eschar seldom. 

In cases where pressure gives relief much benefit has been 
derived from the application of roller bandages. The bandage 
should commence at the toes and extend up to the middle or 
upper part of the thigh. If the pain is relieved by it, it 
should not be removed for several days, or until a cure is 
effected. 



TARALYTIC APHONIA. 181 

Extension and suspension have relieved several obstinate cases. 

The diet should be of the most nutritious character, con- 
sisting of fresh meat, mutton, beef, game, poultry, fresh vege- 
tables, and a liberal supply of cream, butter and other animal 
fats. As in neurasthenia, " the hungry nerve cries out for 
food," and if, owing to lack of power to assimilate, digestion 
becomes embarrassed, or if for any reason the amount of food 
taken is insufficient to satisfy this hunger, so that the "cry" 
is repeated, we cannot do better than to supply the deficiency 
with maltine, or some similar preparation. 

PHARYNGEAL PARALYSIS. 

Synonyms. — Paralysis of the Pharynx; Fr., Paralysie Pha- 
ryngee; Ger., Schlundkopflcihmung. 

Definition. — Paralysis of the pharyngeal branches of the 
pneumogastric nerve. 

Diagnosis. — Paralysis of the pharjmx is usually associated 
with paralysis of neighboring parts, as in labio-glosso-laryngeal 
paralysis (which see). This is the case whenever the disease 
is located at the origin of the nerve in the medulla and in- 
volves adjacent nuclei. But the simple form may result from 
meningeal disease outside the medulla, from disease of the 
bones at the base of the skull, and is occasionally associated 
with diphtheria. A careful examination is usually sufficient 
to distinguish it from organic disease, with which alone it is 
liable to be confounded. 

Pathology. — This is sufficiently indicated under the above 
head. 

Treatment. — Kemove the cause, if possible; if not, give 
Causticum, Gelsemium, Cocculus, Lachesis, Silicea, Cuprum, or 
such other remedy as may be indicated. 



PARALYTIC APHONIA. 

Synonyms. — Paralysis of the Larynx; Fr., Paralysie du 
Larynx; Ger., Kehlkopfldhmung, Stimmlosigkeit. 

Definition. — Loss of voice from paralysis of the laryngeal 
muscles. 



182 NERVOUS THERAPEUTICS. 

Diagnosis. — A laryngoscopic examination will show that 
one or both vocal cords exhibit diminished motion, though no 
mechanical impediment exists. When both crico-arytenoid 
muscles are paralyzed the breathing is obstructed, and even 
when it is deep and prolonged the edges of the vocal cords are 
closely approximated. When the transverse arytenoid mus- 
cles are paralyzed, the posterior part of the rima glottidis opens 
in the form of a triangle. If only one vocal cord is paralyzed 
the voice is weak, deficient in timbre and volume, and some- 
times limited to only a few notes. Some forms of paralytic 
aphonia may be diagnosed without the aid of the laryngoscope, 
as the reflex, the intermittent and the form caused by severe 
mental shocks ; in this last form, although unable to articulate 
words, the patient is able to cough. 

Pathology. — M. Bernard has shown by numerous experi- 
ments that while the spinal accessory specially influences the 
vocal muscles, and is therefore the true vocal nerve, the 
respiratory muscles of the larynx are under the control of the 
inferior and superior laryngeal nerves. He has shown, also, 
that paralysis of these nerves, instead of dilating the vocal 
ligaments, approximates them, so that every effort at inspira- 
tion tends to render the passage of air through the glottis 
more and more difficult by obstructing the laryngeal aperture. 
Hence any interference with the function of the recurrent or 
inferior laryngeal nerve — which is the nerve animating all the 
laryngeal muscles except the crico-thyroid — or with the func- 
tion of the pneumogastric nerve itself, or of one of its branches, 
may produce aphonia. 

Clinical Experience. — The principal remedies for pure 
paralytic aphonia have been found to be Antimonium crud., 
Lachesis, Phosphorus, Baryta carb., Causticum, Kali bich., Cuprum 
met. and Gelsemium. Hysterical and nervous cases usually 
yield to Ignatia, Stramonium, Nux mosch., Belladonna, Nux vom., 
Rhus tox. and Platina. Catarrhal aphonia, which is not truly 
paralytic, is successfully treated with Aconite, Belladonna, Arum 
tri., Causticum, Gelsemium, Antimonium tart., Argentum met., 
Spongia, Iodatum, Mercurius, Bromium, Ammonium brom., Kali 
bich., etc., etc. 



FACIAL PARALYSIS. 183 

Therapeutic Indications. — See cerebral and spinal paralysis, 
pp. 54, 92. 

Auxiliary Treatment. — Paralytic aphonia will sometimes 
yield to a single application of the galvanic current ; in most 
cases, however, several operations are required for the gradual 
restoration of the lost voice. As in other kinds of paralysis, 
the best form, usually, is the induced or secondary current 
(Faradic), but complicated cases sometimes do better with the 
primary current. Massage, the magnetic pad and other local 
measures have sometimes proved curative, and, though seldom 
necessary, may be tried in obstinate cases. 

FACIAL PARALYSIS. 

Synonyms. — Bell's Paralysis, Paralysis of the Portio Dura, 
Histrionic Paralysis; Fr., Paralysie Faciale, Diplegie Faciale; 
Ger., Diplegia Facialis, Gesichtsldhmung. 

Definition. — Paralysis of the facial muscles from disease or 
injury of the portio dura or of its nucleus; 

Diagnosis. — As facial paralysis is often associated with 
hemiplegia, it is important to distinguish it from that disease. 
In facial palsy it is impossible for the patient to close his eye 
on the paralyzed side, which is not the case in the cerebral 
form. If the fifth nerve is paralyzed, and the patient be re- 
quested to close the jaws firmly, the muscles of the sound side 
will contract more energetically and promptly than those of 
the affected side; and if the third nerve is implicated there 
will be ptosis, with dilatation of the pupil and divergent stra- 
bismus. 

Pathology. — In all cases lasting more than a few days 
evidences of defective nutrition may be detected in the nerve- 
trunk as it emerges from the stylo-mastoid foramen. The 
fibres within the pons, and the nucleus beneath the fourth 
ventricle, are sometimes damaged by tumors, haemorrhage, 
softening, etc. The nerve sometimes becomes inflamed from 
the extension of inflammation from the neighboring tissues ; 
and occasionally its function is interrupted by pressure, caused 
by proliferation of the connective tissue of the neurilemma. 



184 NERVOUS THERAPEUTICS. 

Clinical Experience — Facial paralysis has yielded to Gelse- 
miurn, Causticum, Aconite, Kali chlor., Kali iod., Mercurius, Bella- 
donna and Arnica. 

Therapeutic Indications. — Gelsemium. — Bruised pain be- 
hind and above the eyes; heaviness in the lids; impossible to 
close the eye or to raise the lid ; paralysis of the facial muscles 
of the left side. 

Causticum. — Twitching of the lids and eyebrows, especially 
the left ; sensation of heaviness in the upper lid, with inability 
to close the eye firmly ; especially suited to cases caused by 
exposure to cold. 

Aconite. — Recent cases of a catarrhal or rheumatic origin; 
also when due to injury or to inflammation ; anaesthesia of the 
affected muscles. 

Kali chlor. — Paralysis of the facial nerve, especially when 
affecting the muscles of the cheek ; pressure and tension in the 
face ; cramplike drawing in the cheek : inability to puff out 
the cheeks or to blow with the mouth ; especially adapted to 
idiopathic cases. 

Arnica. — Facial paralysis due to injury, especially when there 
is much soreness of the affected parts ; also when there are in- 
flammation and hyperesthesia of the facial nerve. 

Kali iod. — Facial paralysis due to syphilitic disease in any of 
its forms. 

Mercurius. — This remedy is also indicated in syphilitic facial 
paralysis, whether caused by pressure of nodes, inflammatory 
exudations, neuritis or syphilitic disease of the brain. 

Belladonna. — Acute cases, attended with inflammation of the 
nerve, redness of the face, hyperesthesia, throbbing and ex- 
tension of inflammation from neighboring parts, as from the 
tonsils, parotid gland, etc. 

Compare, also, Ignatia, Graphites, Pulsatilla, Cocculus, Xux 
vom., Cadmium, Stramonium, Barium, Opium. 

Auxiliary Treatment. — Hammond, Butler and other elec- 
tricians highly recommend electricity in this disease, the former 
saying that the affection cannot be cured without it. One pole 
of the galvanic current should be placed opposite the stylo- 
mastoid foramen, and the other passed over each of the affected 
muscles in succession, every day. The weakened muscles may 



DIPHTHERITIC PARALYSIS. 185 

be supported, and the mouth drawn toward the centre of the 
face, by means of a double wire hook, curved at the ends and 
of the required length, one end of which should be placed in 
the angle of the mouth and the other over the ear of the 
affected side. 

DIPHTHERITIC PARALYSIS. 

Synonyms. — Postdiphtheritic Paralysis, Asthenic Paraly- 
sis ; Fr., Paralysie Diplitheritique ; Ger., Diphtheritische Lahmung. 

Definition. — Paralysis associated with, or secondary to r 
diphtheria. 

Diagnosis. — Although diphtheritic paralysis resembles that 
which is observed after other acute diseases, and also that 
which occurs in hysterical women, the simple fact that it was 
immediately preceded by an attack of diphtheria is sufficient 
to establish the diagnosis. 

Pathology. — The fact that the nervous centres are not 
always implicated has led to the conclusion that the paralysis 
is peripheral rather than central in its origin. The affection 
appears to extend from the peripheric extremities of the nerves 
toward the nerve-centres; hence, when the nerve-centres are 
involved their implication is probably secondary. 

Clinical Experience. — Gelsemium seldom fails to cure 
promptly all recent cases. Argentum is a good general remedy 
in these cases. Antimonium tart, acts promptly in patients 
suffering from oedema of the lungs. Causticum has cured cases 
of crossed paralysis following diphtheria, one arm and the 
opposite leg being affected ; Arsenicum, where the paralysis 
was confined to the lower extremities ; and Nux vom., Lachesis, 
Cocculus, Arnica and Rhus tox. when limited to one side of 
the body. 

Therapeutic Indications. — See paralysis in general,^. 54, 92. 

Auxiliary Treatment.— Most cases of diphtheritic paralysis 
will yield to the methodical use of electricity ; indeed, it may be 
laid down as a rule that when the muscles will respond to 
either the primary or secondary current recovery will speedily 
follow its application. When this is not the case the fault 
usually lies in the constitution, and we should endeavor, by 

13 



186 NERVOUS THEEAPEUTICS. 

generous diet, fresh air, salt-water baths, exercise, etc., to revo- 
lutionize and build it up ; the paralysis will be found to grad- 
ually disappear as the health improves. 

GLOSSOPLEGIA. 

Synonyms. — Paralysis of the Hypoglossal Nerve, Paralysis 
of the Tongue ; Fr., Paralysie de la Langue; Ger., Zungenlahmung. 

Definition. — Paralysis of the hypoglossal or motor nerve of 
the tongue. 

Diagnosis. — As the hypoglossal nerve is the motor nerve, 
not only for the tongue, but for all the other muscles attached 
to the hyoid bone, with the exception of the stylo-hyoid, the 
mylo-hyoid and the middle constrictor of the larynx, we 
should, in estimating the character and position of the lesion, 
take into consideration the origin, course and distribution of 
the entire nerve. In disease of the nucleus of origin the pa- 
ralysis, which is commonly bilateral, is associated with pa- 
ralysis of the throat and lips, and there is usually more or less 
atrophy. If the disease is seated in the motor tract above the 
nucleus, that is, in the pons, cms or hemisphere, there is hemi- 
plegic weakness on the side corresponding to the paralysis of 
the tongue. When the disease is at the surface of the medulla 
the paralysis, which is commonly unilateral, is associated with 
paralysis of the corresponding half of the palate and vocal 
cord; and when the fibres of origin within the medulla are 
diseased, the paralysis of the tongue is associated with paralysis 
of the opposite limbs, so that the tongue deviates from the par- 
alyzed side. 

Pathology. — The disease is seldom, if ever, a primary affec- 
tion; hence the pathological condition is that of the associated 
disease or of the causal condition on which the paralysis de- 
pends. 

Clinical Experience. — As in all secondary affections, the 
treatment should be that of the causal disease. Where no 
specific disease can be assigned the remedies which usually 
prove most beneficial are: Argentum, Causticum, Plumbum, 
Baryta carb., Opium, Nuz mosch., Dulcamara, Stramonium., Bel- 
ladonna and Hyoscyamus. 



TORTICOLLIS. 187 

Auxiliary Treatment. — The occasional application of elec- 
tricity to the tongue is useful in some cases. The most con- 
venient way of applying it is by means of Tiirck's tongue de- 
pressor, the blade of which should be insulated, where it comes 
in contact with the lips, by a coating of sealing-wax. 



FACIAL SPASM. 

Synonyms. — Spasm of the Facial Muscles, Mimetic Spasm, 
Convulsive Tic; Fr., Spasme Faciale, Tic Convulsif; Ger., Ge- 
sichtskrampf. 

Definition. — Tonic or clonic contractions of one or more of 
the muscles supplied by the facial nerve. 

Diagnosis. — All spasms of the facial muscles not consti- 
tuting a part of a wider convulsive movement, as in epilepsy, 
hysteria, etc., are to be regarded as facial spasms. 

Pathology. — Some cases are purely functional, such as 
nictitation, or involuntary winking. Others are due to irritation 
of the trunk of the nerve by pressure of foreign growths, caries 
of the temporal bone, etc. But the majority are of reflex 
origin, and are due to cold, intestinal worms, etc. 

Treatment. — If possible, remove the cause; if not, consult 
indications under the head of convulsions. 

TORTICOLLIS. 

Synonyms. — Spasm of the Sterno-mastoid Muscle, Wry- 
neck; Fr., Torticolis; Ger., Steifer Hals, Halsstarre. 

Definition. — A tonic contraction of the sterno-cleido-mastoid 
muscle, producing a twisting of the neck to one side. 

Diagnosis. — It is scarcely possible to mistake the affection 
where there is no tumor or organic lesion to account for the 
deformity. 

Pathology. — Wry-neck is a true neurosis, due in many 
cases to irritation of the spinal accessory nerve, conjoined with 
a want of proper antagonization, the latter resulting from 
fatigue or some similarly acting cause. 

Clinical Experience. — Aconite and Cimicifuga will promptly 



188 NERVOUS THERAPEUTICS. 

cure the large majority of recent cases, especially those depend- 
ing on cold and exposure. Belladonna, Rhus tox., Nux vom., 
Dulcamara, Bryonia, Lachnanthes, Cuprum and Mercurius some- 
times relieve in the early stages, but when fully developed 
medicine has very little power over it. 

Auxiliary Treatment. — Galvanization of the affected mus- 
cle and Faradization of the opposite one often give speedy relief 
in recent cases, but neither electricity, nerve-stretching nor 
any other procedure seems to materially benefit chronic cases. 

WRITER'S CRAMP. 

Synonyms. — Scrivener's Palsy, Anapeiratic Paralysis ; Fr., 
Crampe des Ecrivains ; Ger., Schreibekrampf. 

Definition. — A loss of power to perform certain muscular 
movements required in writing, telegraphing, instrument play- 
ing, etc., correctly, owing to a spasmodic action of the mus- 
cles concerned in the movements, due to their long-continued 
use in an unnatural and constrained position. 

Diagnosis. — The history of the case, aided by the location 
of the spasm, will in most cases render the diagnosis sufficiently 
clear. 

Pathology. — As in facial paralysis, torticollis and other 
allied diseases, the paralysis proceeds from the periphery 
toward the centre, whence we infer that the disease is not 
central, but peripheral. What the molecular or anatomical 
changes in the affected parts, or in the nerves supplying them, 
are, is not known. 

Clinical Experience. — But three or four remedies are 
known to have any marked curative power over this affection, 
namely, Gelsemium, Argentum, Strychnia, Arnica and Zincum. 
Recent cases will generally yield to the first of these remedies, 
provided the writer will give the affected muscles sufficient 
time to recover their lost tone, but not without ; the other 
remedies mentioned are less certain. 

Auxiliary Treatment. — Rest, galvanism and gymnastic exer- 
cise of the affected muscles constitute the most effective treat- 
ment in the majority of cases. Rest of the affected muscles, 



SPASM OF THE GLOTTIS. 189 

that is, rest from the particular muscular movements that have 
caused the trouble, is essential, whatever other treatment may 
be instituted. Dr. Poore's plan of directing the continuous 
galvanic current down the muscles of the forearm, at the same 
time requiring the patient to continuously open and close his 
fingers, appears to give good results. The gymnastic treatment 
is similar, so far as the fingers are concerned, but the patient is 
required to execute three or four times a day a series of vigor- 
ous movements of the whole extremity while opening and 
closing the fingers. In this way the old habits are broken up, 
and the nutrition of the affected parts at the same time pro- 
moted. 

SPASM OF THE GLOTTIS. 

Synonyms. — Spasm of the Larynx ; Spasmodic Croup, 
Laryngismus Stridulus; Fr., Spasme de la Glotte; Ger., Kehl- 
kopfkrampf. 

Definition. — Spasmodic closure of the glottis, depending on 
tonic spasm of the adductor muscles of the larynx, producing 
a sudden arrest of inspiration, and ending in a shrill crowing 
sound as the inspiratory act is resumed and concluded. 

Diagnosis.— The disease may be distinguished from acute 
laryngitis, with which it is often confounded, by the absence 
of fever, the greater affection of the breathing, and by the 
absence of the croupy cough, which is the distinguishing 
symptom of the inflammatory affection. A foreign body in 
the larynx closely simulates spasm of the glottis, but the his- 
tory of the case will prevent any error of diagnosis. 

Pathology. — The disease is a pure neurosis, there being no 
anatomical change in the larynx. Excessive reflex irritability, 
arising from constitutional weakness or from some affection 
of the brain or medulla oblongata, is no doubt the chief factor 
in its production. 

Clinical Experience. — The most successful remedies for 
relieving the spasm are : Gelsemium, Sambucus, Belladonna, 
Chlorine, Corallium rub., Lobelia, Ipecacuanha and Kali brom. 
More or less benefit has also been derived from Moschus, Cup- 
rum, Arsenicum, Spongia, Iodine, Lachesis, Aconite, Nux vom., 



190 NERVOUS THERAPEUTICS. 

Ignatia, Phosphorus, Carbo veg., Plumbum, Phytolacca and 
Bromine. 

Therapeutic Indications. — Gelsemium. — Long, crowing in- 
spirations, followed by sudden and forcible expirations. This 
is perhaps the most reliable remedy we have for promptly 
relieving the spasms. 

Sambncus. — Inspirations less labored than expirations ; 
awakes from sleep with symptoms of suffocation ; face livid ; 
gasps for breath ; alternation of perspiration and dry heat ; 
attacks usually occur between midnight and morning. 

Belladonna. — Red face; great arterial excitement; cerebral 
congestion; paroxysms occur during the day or evening; 
excited by drinking. 

Chlorine. — Crowing inspiration, expiration greatly impeded ; 
cyanotic and partially unconscious ; chest inflated by a succes- 
sion of crowing inspirations to a painful extent. 

Iodium. — Attacks provoked by enlarged cervical, bronchial 
and other glands; rachitic and scrofulous children; clayey 
stools ; circulation feeble and easily disturbed by motion. 

Phytolacca. — Frequent spasmodic closure of the larynx ; con- 
traction of the thumbs and toes ; distortion of the face ; eyes 
move independent of each other. 

Plnmbnm. — Spasm of the glottis; asphyxia, with sudden 
arrest of breathing ; mucus rattling in the throat. 

Cuprum. — Convulsive breathing, with cough ; blueness of the 
face and lips ; cough relieved by swallowing cold water ; when 
produced by fright. 

Ipecacuanha. — Blue face and cold extremities at the com- 
mencement of the attack; accumulation of mucus in the 
bronchia. 

Kali brom. — Often relieves night attacks, or when excited by 
the irritation of teething or of worms. 

Corallium rub. — Spasmodic closure of the larynx, with painful 
dyspnoea ; face red, cheeks hot and feet cold. 

Auxiliary Treatment. — The warm bath, with cold water 
dashed on the head and face, usually puts an immediate end 
to the spasm ; afterward cold sponging of the chest, with out- 
of-door exercise, tends to prevent its recurrence. Reflex cases 



FACIAL ATROPHY. 191 

require the special treatment appropriate to each condition. 
Thus, if there is phimosis it should be immediately relieved 
by surgical operation ; if the child is teething the gums should 
be lanced ; if the stomach is overloaded an emetic should be 
given ; and if worms are present they should be dislodged, or 
the virminous irritation allayed, by appropriate treatment. 

FACIAL ATROPHY. 

Synonyms. — Neurotic Facial Atrophy, Unilateral Facial 
Atrophy, Progressive Facial Atrophy, Progressive Facial He- 
miatrophy; Fr., Atropine Partielle de la Face, Aplasie Lamineuse 
Progressive, Trophonevrose Faciale; Ger., Prosopodysmorphia. 

Definition. — An affection in which one side of the face be- 
comes notably smaller than the other, owing to an atrophic 
condition of the cutaneous, subcutaneous and other tissues of 
the affected side. 

Diagnosis. — Progressive facial atrophy may be readily dis- 
tinguished from progressive muscular atrophy, by the fact 
that, when the latter is seated in the face, it is not confined to 
that part, nor to one side of it, as in facial atrophy. In its 
early stages it is liable to be mistaken for facial paralysis, but 
the latter occurs suddenly, while facial atrophy is developed 
very gradually ; moreover, the electro-excitability of the mus- 
cles is always diminished in facial paralysis, which is not the 
case in this disease. 

Pathology. — Microscopical examinations of the affected 
muscles exhibit no degenerative changes of any kind, so that, 
so far as the muscles are concerned, there is simply atrophy 
without degeneration — a condition essentially different from 
what exists in other trophic diseases, such as atrophic spinal 
paralysis, progressive muscular atrophy, etc. From the fact 
that the upper and middle cervical ganglia have been found dis- 
tinctly tender on pressure made over them, Bastion and others 
attribute the disease to persistent irritation acting upon the 
cervical sympathetic; Hammond and others refer it to certain 
hypothetical "trophic nerves;" while Vulpian, who positively 
affirms that it cannot be due to vaso-motor influences acting 



192 NERVOUS THERAPEUTICS. 

on the parts which are the seat of the disease, regards it as an 
essential atrophy, due to some intracranial lesion. This opin- 
ion is based upon the fact that when the disease results from 
traumatic violence inflicted on the head or face its develop- 
ment is accompanied, in the great majority of cases, for several 
years, with pains of greater or less violence seated in the head, 
ordinarily toward the fronto-temporal region. Sometimes, also, 
there are spasmodic movements of the muscles of the face or 
of the jaws ; and in some rare cases there has been numbness 
in the upper extremity of the opposite side. He, however, in 
common with all other authorities, is embarrassed to designate 
a seat for the lesion which can reasonably explain all the 
phenomena of the disease.* 

Clinical Experience. — The only case of this disease that I 
have had an opportunity of treating, though never entirely 
cured, was seemingly arrested by Phosphorus 6 , continued over 
a period of nearly two years. The young lady finally married, 
and I lost sight of her. 

Therapeutic Treatment. — The remedies most likely to 
prove beneficial in this disease are the various preparations of 
Phosphorus, Belladonna, Calcarea, Argentum nit., Stramonium, 
Gelsemium, Baryta, Causticum and Sulphur. 

Auxiliary Treatment. — Bastion claims that marked ame- 
lioration has been produced, in some cases, by the long-con- 
tinued application of a continuous current of weak tension to 
the cervical sympathetic ganglia. 

PERIPHERAL ANESTHESIA. 

Synonyms.— Neural, Cutaneous or Local Anaesthesia ; Ft., 
Anesthesie Cutanee; Ger., Anaesthesia, Andsthesie. 

Definition. — Loss, more or less complete, .of natural, and 
especially of tactile, sensibility. 

Diagnosis. — Cerebral, spinal and cerebro-spinal anaesthesia 
— that is, anaesthesia of central origin — has already been con- 
sidered in connection with the several diseases on which it de- 

* See the author's Intracranial Diseases, p. 153. 



PERIPHERAL ANAESTHESIA. 193 

pends, while anaesthesia of the special senses does not come 
within the scope of this work. The chief point, therefore, in 
our diagnosis is to discriminate between peripheral anaesthesia, 
properly so called, and anaesthesia due to central causes. In 
cutaneous anaesthesia the existence of a peripheral cause will 
be sufficient evidence of the nature of the affection, while, on 
the other hand, anaesthesia of central origin is almost invari- 
ably associated with other marked symptoms of cerebral or 
spinal disease. In anaesthesia of the trigeminus, or fifth pair 
of nerves, the elements of the diagnosis are given by Romberg 
as follows : 

" 1. The more the anaesthesia is confined to single filaments 
of the trigeminus, the more peripheral the seat of the cause 
will be found to be. 

"2. If the loss of sensation affects a portion of the facial sur- 
face, together with the corresponding facial cavity, the disease 
may be assumed to involve the sensory fibres of the fifth pair 
before they separate to be distributed to their respective desti- 
nations; in other w T ords, a main division must be affected be- 
fore or after its passage through the cranium. 

" 3. When the entire sensory tract of the fifth nerve has lost 
its power, and there are at the same time derangements of the 
nutritive functions in the affected parts, the Gasserian gan- 
glion, or the nerve in its immediate vicinity, is the seat of the 
disease. 

" 4. If the anaesthesia of the fifth nerve is complicated with 
disturbed functions of adjoining cerebral nerves, it may be as- 
sumed that the cause is seated at the base of the brain." 

Pathology. — The pathology has been, for the most part, 
sufficiently indicated under the above heading. As cold ap- 
pears to be the principal cause of peripheral anaesthesia, it is 
highly probable, as pointed out by Rendu, that in the major- 
ity of cases neuritis lies at the bottom of the trouble. 

Therapeutic Treatment. — The most important point in the 
treatment is the removal of the cause. Until this is effected medi- 
cine can be of no permanent benefit, while afterward it is 
seldom required. When caused by external injuries, Arnica 
and Hypericum are indicated. Exposure to cold calls for Rhus 



194 NERVOUS THERAPEUTICS. 

tox., Dulcamara, Causticum, Mercurius, Colchicum, Nux vom., etc., 
in prescribing which the accompanying symptoms and condi- 
tions should also be taken into account. 

Auxiliary Treatment. — Friction, massage and electricity are 
among the various means employed to restore the lost sen- 
sibility, the last of which is by far the most efficient. As a 
general rule, the secondary current is to be preferred, and this 
may be rendered still more effective by employing the wire 
brush, as one of the electrodes, upon the affected part. 



PART V. 

DISEASES OF THE SYMPATHETIC NERVOUS SYSTEM. 



HEMICRANIA. 



Synonyms. — Megrim, Nervous Headache, Sick Headache, 
Cephalalgia Periodica; Fr., Migraine; Ger., Migrdne. 

Definition. — A periodical headache, usually confined to one 
side or one half of the head, and frequently attended with 
more or less nausea and bilious vomiting. 

Diagnosis. — The periodicity of the headache, its unilateral 
form, and the gastric disturbances associated with it, sufficiently 
distinguish it from every other affection. 

Pathology. — Formerly the disease was regarded as a pecu- 
liar form of neuralgia, dependent on gastric or hepatic de- 
rangement; but since Du Bois Raymond, who was himself a 
sufferer from it, made a careful study of the phenomena, it has 
generally been held to be due to an affection of the cervical 
portion of the sympathetic nerve, or of its centre in the medulla 
oblongata, giving rise to spasm of the cranial vessels and dis- 
turbances of the sensory nerves of the affected side of the head. 

Clinical Experience. — The remedies which have most fre- 
quently given relief to sick headache are : Sepia, Stannum, 
Belladonna, Sanguinaria, Iris vers., Arsenicum, Calcarea carb., 
Gelsemium, Pulsatilla, Veratrum, Spigelia, Kali bich., Bryonia, 
Cyclamen, Bromine, Niccolum sulph. and Natrum mur. The fol- 
lowing have benefited particular cases: Silicea, China, Nux vom., 
Ignatia, Caffein, Coffea, Carbolic ac, Aurum mur., Aconite, Cimici- 
fuga, Phosphorus, Calcarea acet., Sticta, Zincum valer., Asafcetida 
and Sulphur. 

Therapeutic Indications.— Sepia.— Boring, outward-press- 
ing headache, or when caused by mental emotion, especially 
vexation, and attended with nausea, vomiting, shivering, pale 

(195) 



196 NERVOUS THERAPEUTICS. 

face and flying heat ; ameliorated by pressure, darkness and 
sleep ; periodicity is a marked symptom, especially in females, 
to which this remedy is especially suited. 

Stannum. — One-sided headache in the morning, attended 
with nausea and ill humor ; stupefying pain over the eye and 
in the temple, feeling as if the part would be crushed ; pulsa- 
tive pain in the side of the head, with heat; face pale and 
sunken ; retching and vomiting of bilious matter. 

Belladonna. — This remedy is specially indicated in attacks 
accompanied by congestion of the brain, heat and redness of 
the face, irritation of the sensory nerves of the eye and dilata- 
tion of the pupils ; it acts best on the right side, and when the 
pain is aggravated by light, heat and motion, especially 
stooping. 

Sanguinaria. — Hemicrania, which increases in violence with 
the sun's ascent, decreases as it declines, and is preceded by 
scanty urine, passing off with a profuse flow of urine ; also when 
the attacks occur periodically every week or at longer inter- 
vals ; or when the attacks are most severe on the right side, 
and are followed by chills, nausea, vomiting of food or bile, 
and aggravated by the least movement, relieved only by sleep. 

Iris vers. — Attacks commencing with a blur before the eyes ; 
dull, heavy, throbbing pains, with nausea, vomiting and great 
depression of spirits. 

Arsenicum. — Hemicrania associated with bilious colic, bilious 
vomiting or some affection of the liver; great depression of 
spirits, thinks he will die ; aggravated by cold ; ameliorated 
by warmth ; attacks renewed by going into the open air ; great 
prostration ; feels chilly and is ver} T restless. 

Calcarea carb. — Hemicrania occurring in delicate or scrofulous 
constitutions, with irritable and obstinate dispositions, and 
attended with nausea and vomiting; aggravated, and fre- 
quently induced, by mental and bodily exertion, by exposure 
to the sun, or to cold and damp weather. 

Gelsemium. — Hemicrania accompanied by double vision or by 
dimness of sight, or with great sensitiveness to sounds ; dull, 
heavy pains extending to the nape of the neck, with throbbing 
in the temples, and vertigo on rapid movement. 



HEMICRANIA. 197 

Pulsatilla. — Semilateral headaches where the pupils are con- 
tracted, pulse quick, small and weak, or full and strong, with 
feeling of weakness, or else great strength ; chilliness, followed 
by sweat, sometimes semilateral, nausea and vomiting, no 
thirst, alternations of flushing and paleness; worse before mid- 
night ; suited to delicate, chlorotic girls and to weakly females 
suffering from menstrual irregularities; also to hemicrania in 
the male sex when attended with a feeling of intoxication. 

Veratrum alb. — Attacks attended with great anxiety, fear, 
coldness, small, rapid, intermitting or slow pulse, nausea and 
sometimes vomiting; occasionally attended by a sensation of 
both warmth and coldness on the scalp and sensitiveness of the 
hairs ; cold sweats on the forehead, weakness, faintness and 
profuse micturition ; attacks usually nocturnal. 

Spigelia. — Periodical attacks, generally confined to the right 
temple or to the left eye and left temple, pulsating, darting or 
boring, increasing and declining with the sun, and accom- 
panied with paleness of the face, nausea and vomiting ; aggra- 
vated by motion, stooping, noise, thinking or mental emotion. 

Kali bich. — Hemicrania commencing at the internal angle 
of the eye, "and gradually spreading over the brow and side of 
the head, usually the left ; in many cases there is dimness of 
vision, with aversion to light and noise; pains are usualh T of 
a shooting character, extending from the root of the nose to 
the external angle of the eye ; in other cases the pain is dull, 
heavy and throbbing, and confined to small spots on the side 
of the head. 

Bryonia. — Deep stitching or throbbing pains in the left side 
of the head, with pressure from behind forward, accompanied 
by nausea and vomiting; soreness of the scalp and throbbing 
over the whole side of the head; aggravation from rising, 
stooping or sitting down. 

Cyclamen. — Violent left-sided headache, with heat and throb- 
bing, glittering before the eyes, dimness of vision, chilliness, 
with nausea ; aggravated by motion, especially stooping ; worse 
in the afternoon and evening. 

Bromine. — Hemicrania of the left side of the head, usually of 
but little use on the right side ; throbbing in the forehead and 



198 NERVOUS THERAPEUTICS. 

temple ; pains in the eye, eyelid and eyebrow of the affected 
side. 

Niccolum sulph. — Periodical attacks accompanied by a sense of 
great fulness, heat and stupefaction, setting in on rising and 
increasing until noon, with vertigo and nausea; distress so 
great as to make the patient groan in anguish. 

Natrum mur. — Hemicrania occurring in scrofulous or scor- 
butic constitutions ; attacks periodical and attended with 
marked weakness, prostration, thirst, palpitation and nausea ; 
pains increase and decrease with the course of the sun. 

Auxiliary Treatment. — Absolute rest, low diet and exclu- 
sion from light and noise are efficient means of mitigating the 
distress. The inhalation of three or four drops of Amyl. nit. 
every fifteen or twenty minutes frequently gives speedy relief. 
Morphia, Sulfonal, Antipyrine and Phenacetine, in sensible doses, 
are sometimes given as palliatives, especially in obstinate cases. 
The constant current of electricity has often proved beneficial, 
but is far from being a specific. Care should be taken not to 
make the current too strong, for fear of causing amaurosis. 

EXOPHTHALMIC GOITRE. 

Synonyms. — Exophthalmic Bronchocele, Graves' Disease, 
Basedow's Disease; Fr., Maladie de Graves, Goitre Exophthal- 
mique; Ger., Basedow' sche Krankheit, Glotzaugenkropf. 

Definition. — A nervous affection, characterized by certain 
functioual disturbances of the circulation, and giving rise to 
violent palpitations of the heart, bronchocele and exoph- 
thalmos. 

Diagnosis. — The disease is of such a peculiar character as 
to render an error in diagnosis impossible. 

Pathology. — The true nature of the disease, and the rela- 
tion which the cardiac affection sustains to the bronchocele 
and exophthalmos, are involved in much obscurity and doubt. 
The most rational and generally received theory is that which 
refers the disease to functional disturbances of the sympathetic 
nervous system. Not only do the general symptoms point to 
disturbances of the vaso-motor centres, but the almost number- 



MYXCEDEMA. 199 

less complications of the disease, many of which are of an ex- 
tremely variable and transient character, appear strongly to 
confirm this view of its nature. 

Clinical Experience. — lodium and its various preparations, 
Spongia and Bromine, have effected most of the cures which 
have been recorded, though Lycopus, Badiaga, Cactus, Ferrum, 
Calcarea carb., Belladonna, Baryta carb., Secale cor. and Natrum 
mur. have occasionally been attended with success. The same 
is true of Amyl nit., which is administered by olfaction. One 
of my cases, after resisting all other remedies, yielded perma- 
nently to Bromine 30 . 

Therapeutic Indications. — Although the disease is rich in 
symptoms, they are too variable to be studied outside the ma- 
teria medica. In addition to the remedies above mentioned, 
compare Phosphorus, China, Silicea, Digitalis, Platina, Sepia, 
Cimicifuga, Silicea, Gelsemium and Sulphur. 

Auxiliary Treatment. — Galvanism, applied to the sympa- 
thetic nerve, has been employed with success in many cases, 
especially in curing the goitre and exophthalmus, and also in 
improving the general health ; it is also highly useful in regu- 
lating the menstrual function, upon the disturbance of which 
many cases measurably depend. Whatever tends to invigo- 
rate the system and improve the general health usually exerts 
a beneficial influence upon the disease. The patient should 
therefore abstain from the use of stimulants, take regular but 
gentle exercise in the open air, make use of a plain, but liberal, 
nutritious and easily digestible diet, and avoid all emotional 
or other excitement. 

MYXCEDEMA. 

Synonyms. — The Mucoid Disease, Ord's Cretinoid Affec- 
tion, Mucoid Cretinism ; Fr., Myxedeme ; Ger., Myxddeme. 

Definition. — A disease in which the tissues of the bod} 7 are 
progressively invaded by a mucoid, jelly-like substance, un- 
accompanied by albuminuria or other sign of kidney disease. 

Diagnosis. — The disease is not likely to be confounded with 
anasarca, which it most resembles, as the oedema does not pit 



200 NERVOUS THERAPEUTICS. 

upon pressure, but, on the contrary, is resilient like India 
rubber. In scleroderma the surface is hard, there is no per- 
manent reduction of temperature, as there is in myxcedema, 
and the disease belongs to a much earlier period of life. The 
clubbing of the fingers, as well as the mental symptoms and 
the history of the case, will also serve to distinguish it from 
arsenical or other forms of swelling. 

Pathology. — The mucoid deposit is found in almost every 
part of the body, both at the surface and in all the great nerve- 
centres. The nervous elements undergo yellow degeneration 
or are atrophied, the nerve-fibres are more or less wasted, and 
the small spaces filled with hyaline material. The identity of 
the pathological process in the nerve-centres and in the other 
tissues appears to show that they are not related as cause and 
effect, but form parts of some general disturbance of nutrition. 

Clinical Experience. — Glonoin, Arsenicum, Jaborandi and 
Calcarea carb. are the only remedies that have so far appeared 
to materially benefit these cases. 

Auxiliary Treatment. — Dr. Ord says that he has in two 
cases found benefit from the use of vapor baths. Friction has 
also seemed to benefit some cases. 



ANGINA PECTORIS. 

Synonyms. — Breast-pang, Cardiac Neuralgia, Neuralgia of 
the Phrenic Nerve, Hyperesthesia Plexus Cardica, Sterno- 
cardia, Sternodynia, Sternalgia, Syncope Anginosa: Fr., An- 
gine de Poitrine; Ger., Brustbrdune. 

Definition. — A nervous affection, often complicated with 
organic disease of the heart, characterized by severe paroxysms 
of pain and sense of constriction, commencing in the region of 
the sternum or deep in the chest, and extending over the left 
side of the thorax and the left arm, more rarely over both 
sides and arms; the pain is often associated with faintness 
and anxiety, and with various other senso-motor and vaso- 
motor disturbances. 

Diagnosis. — The diagnosis may be easily made from the 
characteristic symptoms, as given in the above definition, viz. : 



ANGINA PECTORIS. 



201 



great pain, occurring in paroxysms, in the region of the heart, 
accompanied by a sense, rather than fear, of sudden death, by 
the feeling of faintness, constriction and cardiac oppression, by 
the radiation of the pains, etc. 

The differential diagnosis between stenocardia, properly so 
called, and other forms of angina pectoris is as follows : 



Angina Vera. 


Angina Spuria. 


Most frequent at the age of laterio- 


At every age, even during childhood. 


sclerosis, after forty and fifty years. 




More frequent in males. 


More in women. 


Attack provoked by every act necessi- 


Attacks from efforts rare ; the most 


tating an effort ; spontaneous at- 


attacks come on spontaneously'. 


tacks are rare. 




Rarely periodical or nocturnal. 


Mostly periodical, even at the same 




hour, and nocturnal. 


The attack isolated from any other 


Neurotic symptoms frequent. 


symptom. 




The vaso-motor form rare. 


Vaso-motor form frequent. 


Anguish, with sensation of compression 


Sensation of distension of the heart, 


and as in a vise. 


with painful anguish. 


Severe substernal pain. 


The pain more in cardiac region. 


Pain of short duration (2 to 15 min- 


Pain lasting one or two hours and not 


utes), ceasing after the effort. 


ceasing with the effort. 


Attitude, silence, absolute immobility 


Incessant agitation, walks about, rest 


necessary to stop the pain. 


does not stop the pain. 


Coronary scleroses (of the arteries) the 


Neuralgia of the nerves and of the 


cause. 


cardiac plexus. 


Arterial medication. 


Anti-nervous and anti-neuralgia medi- 




cation. 



Pathology. — We see no reason for changing the views we 
have elsewmere expressed on this subject. Notwithstanding 
the fact that organic lesions of the heart are almost always 
associated with angina pectoris, the symptoms are such as to 
require it to be placed among the neuroses, and such is now 
the usual classification. Flint, Anstie, Laennec, Eulenberg, 
Trousseau and others substantially agree in regarding the 
disease as essentially a neuralgia, while Romberg, Friedrich, 
Klapka and others believe it to be a hyperesthesia of the 
cardiac plexus. The author is of the opinion that the spinal 
14 



202 NERVOUS THERAPEUTICS. 

system of nerves is primarily, and the sympathetic system 
secondarily, involved in these cases, and that the spasm is a 
reflex symptom, generally of peripheral, but sometimes of 
central origin. The sources of peripheral irritation are found 
in suppressed neuralgias, in the various organic lesions of the 
heart, and in bronchial, pulmonary and abdominal conges- 
tions ; the central are chiefly, if not wholly, confined to the 
various forms of spinal irritation.* 

Clinical Experience. — While Amyl nit. usually gives the 
most rapid and certain relief during the paroxysm, the most 
successful curative agent is Iodium and its various compounds, 
especially Kali iod. and Natrum iod. Spongia, Cactus, Arsenicum, 
Glonoin, Spigelia, Aconite, Cuprum, Laurocerasus, Veratrum alb., 
Aurum mur., Agaricus and Lachesis have given relief in special 
cases, agreeably to the following 

Therapeutic Indications. — Iodium. — Cramping pressure 
in the region of the heart; spasmodic palpitation of the heart; 
sensation as if the heart was being squeezed together ; paleface; 
great oppression of the chest, with inclination to faint ; anguish,, 
physical and mental, with anxiety. 

Natrum iod. — Organic complications, with frequent attacks 
of angina ; oppressive anguish in the region of the heart, with fear 
of sudden death ; aching pain in the region of the heart, with 
sense of constriction ; anxious feeling, as if something dreadful 
was about to happen ; mind and body greatly depressed. 

Kali iod. — Violent pain in the middle of the chest, extending 
to the shoulder; extremely violent stitches deep in the chest; 
pain in the chest as if cut to pieces ; irresistible desire to go into 
the open air ; torturing feeling of anguish, with oppression of 
breathing and loss of voice. 

Spongia. — Cramping pain in the heart, with great anguish in 
the chest; extreme oppression of breathing, with feeling of suffoca- 
tion; sudden pain and pressure within the chest, with anxiety; 
face pale ; nausea ; lower part of the body feels numb, upper 
part sore and bruised. 

Amyl nit. — Great cardiac oppression and tumultuous action 



* Hart's Diseases of the Nervous System, p. 273. 



ANGINA PECTORIS. 203 

of the heart : aching pain and constriction around the heart, with 
precordial anxiety; visible pulsations of the carotid arteries; 
very severe pain in the region of the heart, extending to the 
right arm; angina pectoris, with great agony; anxiety as if some- 
thing might happen, must have fresh air. 

Natrum nit. — Oppressive anguish in the chest, with dyspnoea; 
aching pain in the region of the heart; cardiac palpitations, 
with anguish ; moderately severe cases of angina pectoris. 

Cactus grand. — Continuous palpitation of the heart, both day 
and night ; worse when walking, at night, and when lying on 
the left side ; sensation as if the heart was grasped by an iron 
hand, preventing movement; angina pectoris, with organic com- 
plications. 

Arsenicum. — Great mental and bodily anguish from severe 
pains in the region of the heart, extending down the arm; 
great dyspnoea and prostration ; surface and extremities cold ; 
attacks followed by numbness and prostration; periodical 
attacks, attended by faintness and extreme weakness; worse 
after midnight and from motion. 

Glonoin. — Syncopal form, with pale face, disposition to faint, 
nausea and extreme anguish of mind and body ; crampy pains 
in the region of the heart, producing a feeling of faintness and sense 
of impending danger; attacks followed by extreme and pro- 
longed prostration. 

Spigelia. — Palpitation of the heart, with anxious oppression 
of the chest; painful constriction in the left side of the chest, 
arresting the breathing and producing an anxious feeling of 
suffocation; pains increased by leaning forward and by motion. 

Aconite. — Constant pressure in the left side of the chest, with 
dyspnoea, increased by exercise; aching, constrictive pain in 
the left side of the chest, with paroxysms of great anguish and 
fear of death; heat and flushing of the face; attacks occurring 
in young, strong, plethoric subjects. 

Cuprum. — Sudden attacks, attended by intense dyspnoea, faint- 
ness and slight convulsions; surface cold and blue; old chronic 
cases, in feeble subjects, with slow pulse and but little vitality. 

Laurocerasus. — Violent attacks, attended by extreme suffering, 
suffocative gasping for breath and loss of speech ; surface cold 
and moist; recent cases, without serious organic complications. 



204 



NERVOUS THERAPEUTICS. 



Veratrirm alb. — Functional cases, attended by excessive an- 
guish, arresting the breathing, and producing a feeling of im- 
pending suffocation: painful constriction of the chest, with 
violent palpitations and cutting pains. 

Agaricus mus. — Cardiac pain and dyspnoea, increased by 
walking, with continued pressure at the pit of the stomach; great 
precordial anguish, with paralytic pain in the left arm, neck 
and nape of the neck: frequent empty eructations. 

Aurum mur. — Palpitation of the heart produced by walking in 
the open air. and increased by continuing to walk, until the 
anguish becomes so extreme as to compel the patient to desist 
from all exercise in the open air, though such patients can walk 
for hours in a close room without inconvenience (Kafka). 

Lachesis. — Sternal pressure and dyspnoea extending to the 
shoulders, and feeling as if the thorax was held by an iron band; 
patient is pale, weak and trembling with anguish; pulse 
small, irregular and intermitting ; surface covered with cold 
sweat ; tendency to faint ; aggravated by motion. 

Compare, also. Xaja trip., Gelsemium. Crotalus, Digitalis, Lyco- 
podium, Cimicifuga, Dioscorea, Angustura, Jloschus, Tabacum. 
Oxalic o.c, Bryonia, Juglans, Asafcetida, Rhus tox., Tarantula, 
Lactuca vir., Arnica, Phytolacca and Sepia. 

Auxiliary Treatment. — Any very strong, stimulating or 
revulsive impression made upon or over the heart during the 
occurrence of a paroxysm will usually put an immediate or 
speedy stop to it. Hence we find that electricity, both the in- 
duced and constant currents, as well as the spraying of ether 
or the application of hot bran poultices over the heart, will 
generally give relief. Many a victim of angina pectoris now 
finds instantaneous relief by carrying with him for immediate 
use a small vial filled with cotton moistened with a few drops 
of Amyl nit., which he can inhale whenever threatened with 
a new attack. 

GASTRALGIA. 

Synonyms. — Xeuralgia of the Stomach, Heartburn, Gastro- 

dynia. Cardialgia Nervosa ; Fr., Gastralgie ; Ger., Magensclvnerz. 

Definition. — A gastric neurosis, characterized by pain, 



GASTRALGIA. 205 

often severe, in or about the stomach, and, as a rule, uncon- 
nected with any other affection of the part. 

Diagnosis. — Gastralgia may be distinguished from acute 
gastritis by the absence of the fever, the persistent vomiting, 
the sensitiveness to hard pressure, and other symptoms belong- 
ing only to the inflammatory affection. Cancer of the stomach 
may be known by the progressive emaciation and steady char- 
acter of the pain which accompanies it. In perforating ulcer 
of the stomach the painfulness and sensitiveness to pressure 
are confined to a small spot, being limited to the seat of the 
ulcer. Dyspepsia, and the passage of biliary calculi, may also 
be distinguished by the symptoms peculiar to each. 

Pathology. — Nothing is positively known concerning the 
pathology of this affection. The symptoms plainly point to 
functional disturbances in both the spinal and sympathetic 
systems of nerves, in the production of which malnutrition 
no doubt constitutes the chief etiological factor. Debility pro- 
duces nervous excitability, and gives rise to a great variety of 
functional disturbances, as we see in hysteria, spinal irritation, 
anaemia, etc. — conditions frequently associated with gastralgia, 
as they are with each other. It is reasonable to infer, there- 
fore, that they all have a common basis in malnutrition of the 
nervous centres, though no organic changes sufficient to account 
for the phenomena are discoverable. 

Clinical Experience. — Nux vom., Ignatia, Arsenicum, Oxalic 
ac, Argentina nit., Bryonia, Carbo veg. and Pulsatilla stand at the 
head of the list as curative agents in this disease, though cures 
have also been effected by Belladonna, Ferrum, China, Petroleum, 
Stannum, Plumbum, Bismuthum, Colocynth, Cocculus, Lachesis, 
Hydrastis, Dioscorea, Veratrum, Aurum mur., Sidphuric ac, Iris 
ver.f Hydrocyanic ac, Ptelea, Cina, Bumex, Sepia, Calcarea carb., 
Nitric ac, Lobelia, Phosphoric ac and many other remedies. 

Therapeutic Indications. — Nux vom. — Clawing, drawing 
and cramping pains in the stomach, with tension and pressure 
between the shoulder-blades ; the pain extends into the chest, 
or downward into the abdomen ; epigastrium sensitive to the 
touch ; pain worse from light pressure and better from hard 
pressure ; gastralgia brought on by high living, indulgence in 
tobacco-chewing and smoking, sedentary habits and habitual 



206 NERVOUS THERAPEUTICS. 

constipation ; pain worse from eating ; pressure in the epigas- 
trium after meals, as from a stone, from indigestion ; heart- 
burn. This remedy alone will, if persevered in, cure the ma- 
jority of cases. 

Ignatia. — Cramping pains in the stomach ; sharp, pinching, 
pressive pains in the pit of the stomach and in the right hypo- 
chondrium ; pressive pain in the epigastrium; a relaxed, 
flabby feeling in the stomach, or an all-gone feeling, as if from 
fasting, with great exhaustion ; hysterical, changeful moods, now 
tearful, silent and melancholy, then impatient, irresolute, ill- 
humored and angry ; burning in the stomach ; regurgitation 
of food ; frequent voiding of large quantities of pale urine ; 
especially suited to hysterical and nervous persons, especially 
females and those addicted to the excessive use of tobacco. 

Arsenicum. — Acute burning, or gnawing, corroding pains, 
accompanied by great restlessness, nervous excitability, cold- 
ness of the extremities, palpitation of the heart and nightly 
aggravations ; feeling as if the stomach was inflamed ; pressure 
in the stomach as from a lump ; vomiting of food as soon as 
taken ; faint, sickly feeling, with pale face and earthy com- 
plexion ; induced by eating ice cream, cake, etc. ; relieved by 
drinking milk. 

Argentina nit. — Severe gastralgia, attended with heartburn, 
which is aggravated or excited by eating ; feeling as if a stone 
lay in the stomach ; gnawing, ulcerative, sore pain, seated at 
one spot, or radiating to different parts, with spinal irritation ; 
pains sometimes appear to depend upon an irritable state of 
the nerves of the stomach proper ; often there are flatulence, 
nausea and palpitation ; pain increases and decreases gradually ; 
hard pressure in the pit of the stomach sometimes relieves. 

Bryonia. — Contractive, pinching pains, relieved by eructa- 
tions ; pressure in the stomach after eating as from a stone ; 
soreness and tenderness in the epigastrium ; bloated feeling in 
the stomach, with stitches and oppression of breathing ; symp- 
toms aggravated by motion and by eating; pains come on in 
chronic cases an hour or two after eating and continue for 
several hours. 

Carbo veg. — Gastralgia, with water brash, coming on about 
3 p.m., with thirst for cold water ; bloating of the stomach, 



GASTRALGIA. 207 

with burning pains, relieved by eructation ; vomiting of large 
quantities of mucus tinged with bile, giving relief; suited to 
cases complicated with hysteria or dyspepsia, especially if there 
is present a hypersemic and irritable condition of the lining 
membrane of the stomach. 

Pulsatilla. — Heartburn when the stomach is empty; sour and 
bitter vomiting, with absence of thirst ; feeling as if food had 
lodged in the oesophagus ; indigestion provoked or aggravated 
by eating rich or fat food. 

Belladonna. — Cramping or shooting pains in the pit of the 
stomach, forcing the patient to bend backward and to hold his 
breath; periodical pains in the pit of the stomach, with 
tremor ; region of the stomach sensitive to the touch ; face 
bloated and congested ; pressing, drawing and clutching pains 
extending to the back, with nausea, thirst and vomiting, ag- 
gravated by drinking water or by motion, and ameliorated by 
eating. 

China. — Gastralgia, attended with great chilliness or coldness, 
constant feeling of weariness and debility, heartburn, with 
sour eructations, bloated abdomen and palpitation of the heart ; 
gastralgia at a certain hour every day or every other day; 
gastralgia after natural or artificial depletions ; torpid liver, 
with jaundiced hue, and large, undigested stools, worse at 
night ; pains aggravated or excited by cold, by eating, by 
fatigue or by mental emotions. 

Oxalic ac. — Gastralgia appearing after eating, with pyrosis 
and cold feeling externally between epigastrium and umbilicus. 

Veratrum. — Pain in the epigastrium, coming on gradually, 
radiating upward to both sides and to the back between the 
scapulae, increasing in violence till it becomes agonizing, then 
gradually wearing off; especially adapted to those cases in 
which the coeliac plexus and sympathetic are involved ; pain 
increases and subsides gradually, and is attended with marked 
coldness of the extremities. 

Coccnlns. — Cramping pains in the stomach, preventing sleep ; 
violent pinching, griping and cramping pains in the epigas- 
tric region ; great distension of the stomach from an accumu- 
lation of gases; especially suited to cases where Nux vom. 
being indicated fails to cure, and pyrosis is not present. 



20S NERVOUS THERAPEUTICS. 

Colocyiith. — Pains paroxysmal and extend into the umbilical 
region, obliging the patient to bend double ; exacerbations re- 
cur every few minutes, are not the result of indigestion, but 
rather, in some cases, of emotional excitement. 

Ferrum. — Anaemic cases, with atony of the stomach; heart- 
burn, with feeling of a load in the stomach ; vomiting imme- 
diately after eating, which usually relieves the suffering; aggra- 
vated or induced by coughing and moving about. 

Bismuthum. — Pressure in the stomach as from a load ; burn- 
ing pain in the stomach, extending to the spine, with water- 
brash, flatulence and extreme prostration ; pains are sometimes 
relieved by bending backward. This is the principal remedy 
of old-school physicians. 

Stanmim. — Heartburn, canine hunger, sinking at the pit of 
the stomach, great uneasiness ; patient finds relief by walk- 
ing ; the pain comes on gradually, extends to the navel, is re- 
lieved by pressure and is very obstinate. 

Consult, also, the other remedies above mentioned, likewise 
the therapeutic indications given under the head of enteralgia, 
p. 212. 

Auxiliary Treatment. — Electricity, sinapisms and fomen- 
tations over the stomach, and similar measures, may be of 
some value during the paroxysms, but careful attention to diet 
and the methodical use of the shower-bath, galvanism, etc., 
during the intervals between the attacks, will, by strengthen- 
ing the system, be of much greater benefit in most cases, espe- 
cially in weakly, neurotic, hysterical subjects. 

OVARALGIA. 

Synonyms. — Pain in the Ovaries, Ovarian Xeuralgia, Ova- 
rian Irritation; Fr., Neuralgie des Ovaires; Ger., Neuralgie der 
Ovarien, Neuralgie der Eierstbcke. 

Definition. — A nervous affection of the ovaries, character- 
ized by pain of a neuralgic character, occurring in paroxysms 
and unattended with inflammation or, necessarily, with en- 
largement. 

Diagnosis. — The pain of ovaralgia is characteristic, being 



OVARALGIA. 209 

neither burning, as in ovaritis, nor pinching, as in colic, but 
sets in suddenly, is attended with distinct remissions, and is 
relieved by pressure; sometimes, also, it shifts to other parts, 
showing clearly its neuralgic character. 

Pathology. — Ovarian hyperemia, resulting from the 
monthly ripening and discharge of the ovum, is the only 
known condition, aside from the neurotic constitution common 
to neuralgic subjects, capable of producing the disease. Neither 
of these conditions, however, are necessary factors in its causa- 
tion, though their combination is a fruitful source of the pain, 
as testified to by many women who never complain of it at 
any other period. The rheumatic diathesis also favors it, as 
it does other forms of neuralgia. These conditions are calcu- 
lated to render the ovaries sensitive to influences which would 
otherwise make no painful impression upon them. 

Clinical Experience. — Ignatia is a reliable remedy in cases 
occurring in hysterical subjects, especially when the pain is 
sharp and irritating, with abundant flow of colorless urine, or 
when the neuralgia is caused by grief; Conium, when, with the 
ovaralgia, there are sharp twinges of pain in the mammae ; 
Lilium tig., when the ovary feels as if squeezed in a vise ; Naja, 
obscure ovarian pains ; Ammonium brom., when the pain is a 
dull, heavy, persistent ache, and is aggravated by excitement; 
Cimicifuga, patients of a rheumatic diathesis, or who are sub- 
ject to menstrual colic and dysmenorrhcea; Ferrum et Strychnia, 
anaemic women, in whom the menstrual flow is scanty and 
the mucous membranes pale ; Zincum vol., in cases of pure 
neurosis, pain shoots down the limb even to the foot, also in 
chronic cases; Chininum ars. or Chininum sulph., when inter- 
mittent or of malarial origin ; Gelsemium, when the pains seem 
to radiate from the spine, or when there is pain in the back of 
the head and neck ; Apis, sharp, cutting pains in the left ovary, 
or contractive, spasmodic pains in the right ovary; compare, 
also, Caulophyllum, Hamamelis and Colocynth. 

Auxiliary Treatment. — Dr. Julia Holmes Smith recom- 
mends the application of hot sand, well saturated with sea- 
water, over the affected ovary; also its exposure, and that of 
the surrounding parts, to the direct rays of the sun for an hour 
every day, affirming that the heat and vivifying power of the 



210 NERVOUS THERAPEUTICS. 

sun's rays make it a valuable curative agent not sufficiently- 
appreciated by the profession. I can fully confirm this testi- 
mony, having witnessed several remarkable recoveries by this 
process while in California, where the sun-bath is generally 
appreciated by all classes. 

HYSTERALGIA. 

Synonyms.— Neuralgia of the Womb, Uterine Neuralgia, 
Irritable Uterus, Uterine Colic; Fr., Fortraiture; Ger., Neuralgie 
der Gebdr mutter. 

Definition. — Neuralgic pains in the uterus, sometimes ex- 
tending through the pelvis, not connected with any demon- 
strable morbid alterations in that organ. 

Diagnosis. — The history of the case, the character of the 
pain, the absence of inflammation, the periodicity of the attack, 
the locality of the suffering, and the fact that the pain is 
usually relieved by pressure, when all are combined in the same 
case, are sufficient not only to establish its neuralgic character, 
but to distinguish it from every other painful affection of the 
part. 

Pathology. — What is said under this heading in the previ- 
ous article applies with equal force to hysteralgia. There is no 
doubt that some forms of dysmenorrhea belong to this cate- 
gory. Indeed, most of those uterine pains which occur between 
and remote from the menstrual periods are usually due to 
some other disorder of the sexual organs, and are seldom cases 
of pure primary neuralgia. 

Clinical Experience. — Cimicifuga is one of our most reli- 
able remedies for uterine neuralgia, especially when it is of 
rheumatic origin : Belladonna has long been a favorite remedy 
for irritable uterus, especially when the pains are sharp, lan- 
cinating and throbbing, and are aggravated by exercise; 
Arsenicum is a valuable remedy if the pains are of a burning 
character and attended by chilliness, hot, dry skin, thirst, rest- 
lessness and anguish ; Calcarea, if the patient has flying pains 
about the pelvis, perspires easily and is poorly nourished; 
Gelsemium, if the patient is hypochondrical, fidgety and com- 
plains of vertigo ; Sepia, if the pains occur at the climacteric 
period; Caulophyllum and Rhus rad., if there is any rheumatic 



ENTERALGIA. 211 

tendency. Compare, also, Platinum, Xanthoxylum, Ignatia, Pul- 
satilla, Nux vom., Veratrum, ZincumvaL, Coffea, Strychnia, Conium, 
Helonias, Aconite, Sabina, Bryonia, Sulphur and others. 

Auxiliary Treatment. — The constant current, applied 
with an insulator through the vagina, hot vaginal injections, 
hot compresses and similar measures often afford considerable 
relief. Hygienic treatment as in other forms of neuralgia, 
which see. 

ENTERALGIA. 

Synonyms. — Neuralgia of the Bowels, Enterodynia, Neu- 
ralgia Mesenterica, Neuralgia Meseraica ; Fr., Nevralgie Intesti- 
nale; Ger., Neuralgie der Eingeweide, Darmweh. 

Definition. — An affection of the nerves of the intestines, 
characterized by paroxysms of sharp, intense pain, without in- 
flammation or any discoverable organic lesion. 

Diagnosis. — The disease is very apt to be confounded with 
colic ; indeed, many authors regard enteralgia and intestinal 
colic as essentially one and the same disease. The chief 
difference between the two affections lies in the fact that 
enteralgia is a true neuralgia, while colic is dependent on 
spasm of the muscular walls of the intestines. In the former 
the pains are darting or lancinating, in the latter twisting or 
griping. An error in this particular is, however, of but little 
consequence, since the treatment is essentially the same in 
both. Enteritis and other inflammatory affections may be 
known by the presence of inflammatory symptoms, such as 
fever, thirst, tenderness on pressure and the stationary char- 
acter of the pain, none of which symptoms belong to enteralgia. 

Pathology. — Impaired vitality of the nerve-centres, whether 
resulting from hereditary weakness, anaemia, malaria, plum- 
bism, or any form of blood deterioration, lies at the foundation 
of neuralgia, and enteralgia is no exception to the rule. What 
the exact relation between them is, other than that of cause 
and effect, is simply a matter of pure speculation; but, consider- 
ing the nature of these etiological factors, it is reasonable to infer, 
as already pointed out, that the disease is dependent on mal- 
nutrition of the nerve-centres, and this view is confirmed by 
the apparently central origin of the affection. 



212 NERVOUS THERAPEUTICS. 

Clinical Experience. — Enteralgia resembling colic, or 
when arising from indigestion, usually yields to Nux vom., Pul- 
satilla, Dioscorea, Colocynth, Arsenicum or Chamomilla; lead 
colic, or enteralgia resembling it, Alumen, Alumina, Platina, 
Opium, Podophyllum; abdominal hyperesthesia, Plumbum,. 
Cuprum, Zincum, Stannum. 

Therapeutic Indications.— Nux vom.— Neuralgia of the 
bowels from indigestion or overeating ; attacks resulting from 
dissipation or from sedentary habits; periodical attacks occurring 
after eating or after regular meals ; pains relieved by bending 
double or by lying on the face ; constipation; diurnal drowsi- 
ness. 

Arsenicum. — Attacks coming on suddenly after eating and 
drinking, especially after partaking of ice water, cake or ice 
cream ; periodical attacks due to malarial influence ; neuralgic 
attacks folloived by great 'prostration, the strength suddenly 
sinking ; burning, cutting pains, attended by great restlessness 
and intolerable suffering ; paroxysms attended by nausea and 
vomiting, or with thin, watery stools; pains worse at night, 
also after eating and drinking, better from warm applications. 

Colocynth. — Pains appear to radiate from the umbilicus, are of 
a sharp, cutting, darting or twisting character, and occur in 
paroxysms ; relieved by bending double or by hard pressure ; 
coffee and smoking relieve, but food and other kinds of drink 
usually aggravate. 

Dioscorea. — Severe colic-like pains, which do not intermit and 
are aggravated by rest ; relieved by stretching the body out or 
by walking about; hyperesthesia of the abdominal nerves; pains 
shift their location suddenly and appear in distant parts, as the 
fingers and toes ; stools bilious and offensive. 

Chamomilla. — Colic-like pains in the region of the navel, also 
lower down on both sides, with pain in the hollow of the back 
as if broken ; abdomen swollen and drumlike ; flatus passed in 
small quantities without relief; relieved by warm applications. 

Podophyllum. — Lead colic; frequently recurring attacks, ac- 
companied by retraction of the abdominal walls; severe straining 
during stool, with escape of flatus; morning aggravations; 
attacks renewed by eating and drinking. 



ENTERALGIA. 213 

Alumina. — Lead colic; paroxysmal pains, with dyspnoea, worse 
when stooping ; violent cutting pains, principally in the 
evening, succeeded by oppression of the chest ; colic-like pain, 
followed by diarrhoea and pain in the region of the kidneys ; 
pinching and lacerating pain, with chilliness in the abdomen, 
relieved by heat. 

Opium. — Lead colic; violent cutting pains in the abdomen, as 
if made with a knife; constipation, with hard and distended 
abdomen; pains worse before and after stool; hypochondria 
painful when touched. 

Plumbum. — Excruciating pains in the umbilical region, shoot- 
ing to other parts, and moderated by pressure ; recti muscles 
hard and knotty; abdomen retracted to the utmost extent; 
ameliorated by hard pressure and by friction ; obstinate con- 
stipation ; pains resembling lead colic, but due to some other 
cause. 

Cuprum. — Violent cutting, drawing, intermittent pains ; ab- 
domen retracted and sore to the touch ; pains cause the patient 
to utter fearful screams ; very restless and uneasy, constantly 
tossing about ; worse by drinking cold water. 

Platiua. — Lead colic; severe colic-like pains, with sensation of 
burning and writhing around the abdomen, with oppressed 
breathing, and with a tremulous sensation through the whole 
body ; drawing pains, extending from the chest to the groins 
and into the genital organs ; patient screams and tosses about 
in every direction to relieve his suffering. 

Belladonna. — Violent cutting, clutching, clawing pains in 
various parts of the abdomen, constantly shifting about, ap- 
pearing and disappearing suddenly; light pressure aggravates, 
but hard pressure relieves; thirsty, but drinks little, as drink- 
ing aggravates the pains ; tendency to cerebral hyperemia ; 
worse until evening and after midnight. 

Compare, also, Ignatia, Cocculus, Mercurius, Aconite, Phos- 
phorus, Rhus tox., Veratrum, Iris vers, and Sepia. 

Auxiliary Treatment. — Hot fomentations, warm or hot 
water enemas, frequently repeated, mustard foot-baths, hot 
Aconite and Chloroform liniments often give great relief. In 
lead colic it is sometimes necessary to resort to Morphia, which 
is best given hypodermically. 



PART VI. 

SYMPTOMATIC DISEASES. 

CEPHALALGIA. 

Synonyms. — Headache; Fr., Cephalalgie, Bouleur de Tete, 
Mai a Tete; Ger., Kopfschmerz. 

Definition. — Pain in the head, usually symptomatic of some 
other affection. 

Diagnosis. — Hemicrania is the only affection liable to be 
confounded with it. In hemicrania the pain is more or less 
unilateral, is frequently associated with nausea and bilious 
vomiting, is generally ushered in by premonitory symptoms, 
and is usually of a periodical character — peculiarities which 
do not characterize ordinary headache. 

Pathology. — Excluding hemicrania as a separate disease, 
headaches, though embracing numerous forms or varieties, 
may be conveniently arranged in three separate classes, namely : 
(1) structural headaches, or those depending upon disease within 
the cranium; (2) congestive headaches, which may be either 
active or passive; and (3) toxemic headaches, which include not 
only those of a rheumatic, syphilitic and other dyscracic char- 
acter, but all those which attend fevers and inflammatory 
affections, some of which are also partly congestive. This 
classification is of itself sufficiently descriptive of their nature. 

Clinical Experience. — Congestive headaches generally yield 
to Belladonna, Aconite, Ammonium carb., China, Cactus, Glonoin, 
Ferrum, Asclepias syr., Pulsatilla, Digitalis, Cimicifuga, Carbo veg., 
Calcarea carb., Alumina, Atropine, Amyl nit., Chamomilla, Bryonia, 
Camphor, Cocculus, Gratia, Fluoricum ac, Causticum, Caladium,, 
Arnica, Agaricus, Capsicum and Gelsemium; or else to Kali carb., 
Lycopodium, Mercurius cor., Lachesis, Hamamelis, Magnesia 
carb., Silicea, Theridium, Sepia, Nux vom., Sanguinaria, Naja, 

(214) 



CEPHALALGIA. 215 

Kali iod., Cuprum, Lachesis, Lilium tig., Natrum sulph., 
Opium, Stramonium, Veratrum vir., Nitric ac, Phosphoric ac, 
Psorinum, Spongia, Lachnanthes, Sulphur and Phosphorus. 

Remedies and indications for nervous headache. — See hemicrania. 

Remedies successfully employed in the various forms of sympto- 
matic and sympathetic headaches are given below in connection 
with the therapeutic indications. 

Therapeutic Indications. — Chamomilla. — Pains stinging, 
stitching, tearing and pressing; seat, forehead, temples and 
vertex; aggravated by mental exertion; ameliorated by mo- 
tion ; especially suited to children ; arthritic and rheumatic 
headaches, especially when attended by vertigo, nausea and 
vomiting. 

Berberis. — Pains lacerating, darting, tensive or aching ; face 
pale, cheeks sunken, eyes with bluish-black circles; arthritic, 
menstrual and rheumatic headaches, especially when complicated 
with hepatic troubles ; aggravated by motion, stooping, after- 
noon ; ameliorated in open air. 

Ipecacuanha. — Pains stinging, throbbing, lacerating ; accom- 
panied by nausea, vomiting, drowsiness, heaviness of the head ; 
aggravated by stooping or moving the head ; ameliorated out 
of doors. 

Natrum sulph. — Characterised by fulness," heat in the vertex, 
pressure, vertigo, nausea, vomiting; menses late and scanty; 
mood sad and depressed ; worse in the forenoon ; menstrual 
headache occurring periodically, every spring. 

Lachesis. — Pains throbbing, beating, lacerating, pressing; 
seat, forehead, temples, vertex, over the eyes; giddiness just 
before the menses; nausea and vomiting; pain in left ovarian 
region; ameliorated by lying down; headaches catarrhal, hyste- 
rical, menstrual and rheumatic. 

Sepia. — Pains pressing, stinging, stitching, often one-sided, 
usually the right; nausea and vomiting, with aversion to 
food ; aggravated by noise and motion ; ameliorated by rest, 
darkness and sleep ; gastric, hysterical and rheumatic headaches, 
or headaches depending on derangement of the digestive or 
sexual systems. 

Belladonna.— Pains sudden in their appearance and disap- 



216 NERVOUS THERAPEUTICS. 

pearance, but last indefinitely ; often accompanied by stupefac- 
tion and vertigo, redness and swelling of the face ; aggravated 
by noise, light, shock or contact ; catarrhal, gastric and rheu- 
matic headaches, especially in lymphatic or scrofulous subjects; 
cerebral congestion. 

Anacardium. — Gastric headache caused by indigestion ; nausea, 
with retching, soon after drinking cold water ; weak digestion, 
with fulness and distension of the abdomen ; symptoms dis- 
appear after dinner and reappear two hours afterward. 

Aconite. — Pains piercing, throbbing, stupefying; headache, 
with fever, especially when produced by exposure to cold, 
suppressed perspiration or currents of air; accompanied by 
roaring in the ears, chilliness, restlessness, wakefulness ; aggra- 
vated by noise, light or motion ; catarrhal and menstrual head- 
aches, especially at the commencement. 

Causticum. — Pains throbbing, tearing, stitching ; seat, chiefly 
in vertex, spreading to forehead and temples ; accompanied by 
nausea and vertigo ; aggravated by stooping, reading, looking 
up, shaking the head; ameliorated in the open air; arthritic 
and rheumatic headaches, especially in the scrofulous. 

Nux mosch. — Pains pressing, throbbing, tearing ; confined to 
small spots; bloating of stomach and abdomen ; seat, chiefly in 
forehead and temples; aggravated by eating, emotional excite- 
ment, menstrual congestion, changes in the weather; hysterical 
headache, especially when complicated with gastric troubles. 

Silicea. — Pains pulsating, pressing, tearing, frequently one- 
sided ; accompanied by nausea, vomiting, frequent cold sweat 
about the head, or vibratory sensations in the head; aggra- 
vated by noise, light, motion, even the slightest jar ; amelio- 
rated by warmth, darkness and sleep; gastric and rheumatic 
headaches. 

Sulphur. — Catarrhal and gastric headaches, especially in scrofu- 
lous patients; or when associated with constipation, morning 
diarrhoea or haemorrhoids ; or when caused by abdominal 
plethora, suppressed eruptions or mental exertion, or when 
beginning, increasing and ending with the daily course of the 
sun ; aggravated by motion, stooping, wet and cold weather, 
heat of the bed or mental exercise ; ameliorated by pressure 
and moderate warmth. 



CEPHALALGIA. 217 

Phytolacca. — Pains sharp, shooting, or dull and heavy; seat, 
forehead and temples ; accompanied by vertigo, dimness of 
vision, nausea; aggravated by damp weather; gastric and 
rheumatic headaches, especially in syphilitic subjects. 

Lycopodium. — Pains chiefly pressing and lacerating; seat, 
forehead and temples; characterized by great restlessness and 
disposition to faint ; worse in the afternoon ; gastric, bilious and 
rheumatic headaches. 

Colocynthis. — Pains tearing, aching, drawing, compressive, 
often one-sided ; accompanied by restlessness, anguish, vertigo, 
nausea, or vomiting of bitter, yellowish fluid ; aggravated by 
motion, stooping, bending the head forward ; ameliorated by 
pressure ; arthritic and rheumatic headaches, especially those of 
an intermitting type. 

Euphrasia. — Catarrhal headache; headache accompanied by 
profuse watery coryza, smarting of the eyes, lachrymation, 
photophobia, or sneezing and discharge of mucus; aggravated 
by cold in the head. 

Iris vers. — Pains shooting and throbbing, or dull and heavy ; 
seat, chiefly in the forehead ; accompanied by nausea and vom- 
iting, first of sour, watery fluid, then of bile; paroxysms of pain, 
followed by copious emissions of urine and vomiting, with 
great burning and distress in the stomach; bilious and gastric 
headaches, always beginning with a blur before the eyes. 

Arsenicum. — Pains burning, beating, pressing, drawing or 
throbbing; sometimes associated with a fluent burning and 
excoriating coryza ; often attended with a burning nausea and 
the characteristic thirst; ameliorated by warmth, wrapping 
up the head or by rubbing ; cold water only relieves tempo- 
rarily ; catarrhal, gastric and malarial headaches, especially those 
of an intermitting or periodical character. 

Bovista. — Menstrual headache, characterized by deep-seated, 
stupefying pains ; putrid, bitter taste, with nausea and empty 
eructations; morning sickness, relieved by eating breakfast; 
aggravated by pressure and by sitting up. 

Caulophyllum. — Pains contractive or pressive, paroxysmal or 
intermitting; pressure behind the eyes, with dimness of sight; 
menstrual irregularities, with " moth " spots on the forehead ; 
15 



218 NERVOUS THERAPEUTICS. 

aggravated by stooping, light and noise ; menstrual and rheu- 
matic headaches. 

Grelsemium. — Catarrhal and hysterical headaches, appearing 
suddenly, with vertigo, dimness of sight and double vision ; 
often accompanied by slight nausea; ameliorated by shaking 
the head; pain in the back of the head and neck, extending 
to the shoulders, also across the forehead and temples ; relieved 
by profuse urination. 

Mezereum. — Catarrhal headache in scrofulous and syphilitic 
subjects ; headache extending from the root of the nose 
into the forehead, as if everything would press asunder, with 
pain in the temples when touched ; heat and perspiration on 
the head, with chilliness and coldness of the rest of the body. 

Kali carb. — Catarrhal headache, especially in aged people 
inclined to obesity ; pains are of a sticking character, worse 
when stooping or moving the head, better from raising the 
head and from warmth ; constipation. 

Nux vom. — Pains pressing, drawing, stupefying, affecting the 
whole or any part of the head, but especially the forehead ; 
accompanied by more or less dizziness, nausea and inclination 
to vomit; aggravated by motion, stooping, moving the eyes, 
noise, light and mental exertion ; gastric and bilious headaches, 
attended by constipation, and brought on by a debauch, wine, 
coffee, sedentary habits, or too close mental application. 

Podophyllum. — Gastric, rheumatic and bilious headaches, espe- 
cially when associated with torpidity of the liver ; or when 
alternating with diarrhoea, or when accompanied by bitter taste 
and risings, giddiness, glimmering before the eyes ; nausea, 
bilious vomiting and purging; worse in the morning; better 
from pressure and from lying quiet in the dark. 

Stramonium.— Hysterical and rheumatic headaches, especially in 
young and plethoric persons ; swollen face, with glistening 
eyes ; vertigo when walking in the dark ; heat and pulsations 
about the vertex, accompanied by faintness and loss of sight 
and hearing; aggravated by cold; ameliorated by warmth 
and quiet. 

Platina. — Pains drawing, crampy, affecting chiefly the fore- 
head ; face usually red and hot ; numb feeling in the brain ; 



CEPHALALGIA. 219 

mood variable, sometimes cheerful, at others depressed ; aggra- 
vated by stooping and by being in a warm room ; ameliorated 
by going into the fresh air ; hysterical headache, especially in 
young girls with erotic desires, or who are suffering from 
amenorrhea or from profuse menstruation. 

Kali iod. — Pains tensive, stinging, shooting and tearing; 
seat, every part of the head, especially the forehead ; head- 
ache accompanied with inflammation of the frontal sinuses, 
nose, eyes and throat; swelling of the cervical glands; violent 
sneezing, with running of acrid water from the nose, excori- 
ating the skin ; catarrhal headache, especially in scrofulous, 
and syphilitic subjects. 

Grynmocladus. — Catarrhal headache, especially during the early 
stage, characterized by fulness, throbbing in the forehead: 
and temples, vertigo, numbness, heat of face and exhaus- 
tion ; frequent violent sneezing, originating high up in the 
nose ; dizziness, with dimness of sight, nausea and eructation. 

Chelidonium. — Pains heavy, drawing and pressing; accom- 
panied by nausea and bilious vomiting ; aggravated by motion ; 
ameliorated by rest, pressure and closing the eyes ; bilious 
headaches, affecting especially the right side of the forehead 
and the right temple. 

Eupatorium perf. — Pains shooting and throbbing ; seat, chiefly 
in the vertex, temples and occiput ; vomiting of food and bile ; 
tongue coated white or yellow ; attacks generally occur in the 
morning between 7 and 9 a.m.; aggravated by heat; amelio- 
rated by pressure ; bilious and malarial headaches. 

Asafoetida. — Pains darting, stitching, jerking ; they sometimes 
disappear by the touch, or are transformed into other pains ; 
hypochondriacal and hysterical restlessness, with anxiety ; 
ameliorated by walking in the fresh air; hysterical headache in 
hypersensitive subjects. 

Allium cepa. — Catarrhal headache, with coryza ; copious watery 
discharge from the nose and eyes; worse in the evening; 
better in the open air. 

Bismuthum. — Gastric headache, complicated with gastralgia ; 
pain comes on immediately after eating and is relieved by 
vomiting; pains chiefly frontal; aggravated by motion. 



220 NERVOUS THERAPEUTICS. 

, Hydrastis. — Catarrhal headache, especially in debilitated sub- 
jects, or when troubled with mucous discharges ; pale face, 
with worn and weary appearance ; myalgic pains in the scalp 
and muscles of the neck ; discharge of thick white mucus 
from the nose ; cachectic condition, with loss of appetite and 
fainting turns ; subacute and chronic cases. 

Gossypium. — Menstrual headache, with drawing and stinging 
pains extending from the temples to the centre of the fore- 
head ; nausea, with inclination to vomit ; menses last only 
about twenty-four hours, and are scanty and painful. 

Mercurius. — Pains burning, stitching, tearing, pressing ; accom- 
panied by catarrhal affections of the head and throat; disposed 
to sweat easily ; chronic cases, complicated with ozsena, the pain 
extending to the root of the nose and frontal sinuses ; catarrhal 
and rheumatic headaches, especially when occurring in syphilitic 
subjects. 

Phosphorus. — Pains burning or throbbing, seated in the fore- 
head or temples, often semilateral ; accompanied by nausea, 
vomiting, vertigo, with a tendency to fainting, especially in 
the morning on rising; sudden changes of mood, from grave 
to gay, from laughing to weeping ; aggravated by stooping, 
music, mental and moral disturbances or abuse of stimulants ; 
hysterical headache. 

Alumina. — Chronic catarrhal headache, especially in scrofulous 
subjects; head feels heavy, with oppression in the forehead; 
pressive, stupefying pain in the frontal region ; aggravated by 
being in a warm room, or by going up stairs or stepping; 
ameliorated by pressure. 

Bryonia. — Pains throbbing, digging, sticking, burning or 
pressing ; seat, any portion of the head, but especially the 
temples ; usually associated with soreness; aggravated by stoop- 
ing or by quick motion ; gastric and rheumatic headaches, 
especially when accompanied by nausea or vomiting, or when 
arising from indigestion. 

Cedron. — Pains of a shooting character, located chiefly in the 
frontal region, often extending to the orbits ; when severe 
they are often accompanied by palpitation and quickened 
respiration; malarial headaches, coming on with clocklike 
regularity. 



CEPHALALGIA. 221 

Gamboge. — Gastric headache, with compressive and heavy 
pains in the forehead and temples ; accompanied with vomiting, 
purging- and fainting; drowsy, heavy feeling in the whole 
head, with pain in the small of the back; watery diarrhoea, 
with colic and tenesmus; ameliorated in the open air. 

Natrum mur. — Menstrual headache, occurring periodically, 
during the menses, every spring ; characterized by fulness, heat 
in the vertex, pressure, vertigo, nausea, vomiting ; menses late 
and scanty ; sad and depressed mood ; -worse in forenoon. 

Pulsatilla. — Pains of almost every variety, and often one- 
sided ; accompanied by more or less vertigo, nausea, bad taste 
in mouth, without thirst ; ivorse in bad weather ; better from 
pressure, also in the open air ; gastric, menstrual and rheumatic 
headaches, especially w T hen due to menstrual irregularities, 
mental exertion, fat food, abuse of coffee or spirits, or exposure 
to damp, cold weather. 

Stilliugia. — Catarrhal headache in syphilitic and scrofulous 
constitutions; dull, heavy, stupefying pains in the frontal re- 
gion; dizziness, with throbbing in the head; headache accom- 
panied with inflamed and watery eyes and general soreness of 
the muscles ; chronic cases which have been aggravated by 
mercurial treatment. 

Rumex. — Pains generally dull, but sometimes sharp and 
piercing ; aggravated by motion ; catarrhal headache, with great 
irritation of the larynx and soreness behind the sternum. 

Scutellaria. — Hysterical headache, especially when caused by 
mental emotion; pain worse over the right eye; ameliorated 
by moving about in the open air; urine scanty before and 
profuse after the headache. 

Lilium tig. — Menstrual headache, especially in cases due to 
menstrual irregularity arising from prolapsus or malposition 
of the uterus, and causing strangury and ineffectual urging 
to stool ; pains in the forehead and temples, with vertigo and 
depression of spirits ; constant bearing down in the lower 
part of the abdomen, with severe pressure in the ovaries, 
rectum and anus, with constant desire for stool ; bearing-down 
pressure in the vagina, as if everything would be pressed out ; 
worse from rising up and from standing. 



222 NERVOUS THERAPEUTICS. 

Kali bich. — Catarrhal and rheumatic headaches, the former ac- 
companied by ozsena; frontal headache, complicated by a 
chronic catarrhal condition of the nasal and other mucous 
surfaces; aggravated by moving, stooping or mental exertion; 
ameliorated by hard pressure. 

Crocus. — Menstrual headache, of. a pressive, burning and 
throbbing character, affecting the forehead, temples and top of 
the head ; vertigo, with confusion and webs before the eyes ; 
headache at the climacteric period, most severe at the time 
corresponding to the monthly periods, lasting two or three 
days and nights; excitable and variable disposition. 

Argentina nit. — Gastric headache in nervous persons; usually 
attended with chilliness and trembling of the body, intense 
nausea and vomiting ; giddy and very restless ; worse in the 
open air ; better from bandaging the head. 

Cocculus. — Gastric and menstrual headaches, with a feeling of 
emptiness in the head ; violent headache which compels the 
patient to sit up, aggravated by talking, laughing, noise and 
bright lights. 

Sanguinaria. — Gastric and rheumatic headaches, most severe on 
the right side, affecting especially the frontal region and tem- 
ples; accompanied by nausea and vomiting; attacks usually 
paroxysmal, with more or less chilliness and burning in the 
stomach; aggravated by motion, light and noise; ameliorated 
by quiet, darkness and sleep. 

Antimonium crud. — Gastric headache, with aversion to food ; 
tongue coated white ; aching of the limbs, nausea and vomit- 
ing; anorexia, risings and inclination to vomit; symptoms 
ameliorated in the open air. 

Carbo an. — Menstrual headache, chiefly in forehead and ver- 
tex ; pains pressing, throbbing, tearing; accompanied by vertigo, 
sometimes by nausea ; vertigo and nausea on raising the head 
after stooping ; menses too early and too long, but not too great, 
followed by debility and prostration. 

Calcarea phos. — Gastric and rheumatic headaches, with fulness 
and pressure in the head, and with vertigo when walking or 
moving ; patient dull, peevish, quarrelsome and forgetful ; 
aggravated by changes in the weather, eating and mental and 
bodily exertion ; ameliorated by cold washing. 



VERTIGO. 223 



VERTIGO. 



Synonyms. — Swimming of the Head, Dizziness, Giddiness ; 
Ft., Vertige; Ger., Seine indel. 

Definition. — The consciousness on the part of the patient of 
disordered equilibration of the body. 

Diagnosis. — It is impossible to mistake this condition for 
any other subjective symptom. It is not always easy, how- 
ever, to determine whether labyrinthine vertigo is primary or 
secondary. To do this we have to consider the presence or 
absence of certain symptoms. Thus, tinnitus and deafness 
without vertigo indicate disease of the middle ear ; the same 
is true of tinnitus and vertigo without deafness. But in order 
to clear up the diagnosis in these cases, we should test the con- 
dition of the conducting apparatus, ascertain the permeability 
of the Eustachian tube, and make an otoscopic examination of 
the membrani t} r mpani, since it is not until this is done that 
we are prepared to estimate the significance of the syncope, 
nausea, vomiting and other like indefinite symptoms. 

Pathology. — It is not always easy to determine with pre- 
cision which of the sensory impressions is concerned in this 
or that particular case of vertigo. Sometimes the impressions 
are labyrinthine when they appear to be ocular, and vice versa. 
Doubtless in some cases the two forms are combined. This is 
the more probable from the fact that variations in labyrinthine 
tension may be caused by differences in the vascular tension 
of the labyrinthine bloodvessels, and a similar cause may, and 
often does, operate in the case of visual disturbances. Not 
only do labyrinthine, visual and tactile disturbances give rise 
to vertigo, but, as is well known, the latter is often caused by 
derangement of the stomach and other viscera. This is easily 
accounted for by the close and important nervous relations 
which the labyrinth sustains to these organs. For example, 
the nucleus of the vestibular nerve, which supplies the semi- 
circular canals, and which is a branch of the auditory nerve, 
is in close relation to the nucleus or internal origin of the 
pneumogastric. Finally, those diseases, as well as those medi- 



224 NERVOUS THERAPEUTICS. 

cines, which cause variations in the labyrinthine tension may 
also give rise to vertigo.* 

Clinical Experience. — We should never forget that vertigo 
is a mere symptom, indicative of some abnormal condition, 
the removal of which is essential to cure. The remedies which, 
irrespective of the cause, most frequently relieve are : Phos- 
phorus, Nux vom., Arsenicum, China, Chininum sulph. and Pulsa- 
tilla. The following can usually be relied upon in the several 
conditions named : 

Nervous Vertigo. — Nux vom., China, Chininum sulph., Arseni- 
cum, Ferrum, Phosphorus, Phosphoric ac, Pulsatilla, Ignatia, 
Zincum, Silicea. 

Gastric Vertigo. — Nux vom., B^onia, Arsenicum, Ipecacu- 
anha, Pulsatilla, China, Carbo veg., Sepia, Ignatia, Phosphorus, 
Calcarea, Tarantula, Sulphur and Natrum mur. 

Epileptic Vertigo. — Belladonna, Stramonium, Hyoscyamus, 
Arsenicum, Amyl nit. and Glonoin. 

Ocular Vertigo. — Causticum,Gelsemium, Argentum nit., Phos- 
phorus, Physostigma, Nux vom., Rhus tox., Spigelia, Paris 
quad., Senega, Euphrasia and Cuprum acet. 

Auditory or Labyrinthine Vertigo. — Natrum sal., China, Chini- 
num sulph., Rosa damas., Colchicum, Aconite, Kalmia, Sali- 
cylic ac, Conium and Cicuta. 

Therapeutic Indications. — Phosphorus. — Vertigo accom- 
panied by reeling, nausea, vomiting ; vertigo occurring in the 
morning, with an empty stomach, after eating or sleeping, 
during or after the menses, or with fainting and trembling ; 
ocular, gastric or nervous vertigo, especially when caused by 
nervous debility, sexual abuse, spermatorrhoea or haemorrhoids ; 
worse after eating. 

Nux vom. — Vertigo, with tendency to faint, worse during and 
after meals ; vertigo associated with dyspepsia and constipa- 
tion ; vertigo brought on by mental exertion, sedentary habits, 
high living or haemorrhoids ; vertigo in nervous and hysteri- 
cal subjects ; ocular, nervous or gastric vertigo, or when caused 



* From the author's work on Intracranial Diseases, pp. 269-271, where this sub- 
ject is treated somewhat at length. 



VERTIGO. 225 

by paresis of the ocular muscles from the use of stimulants or 
tobacco ; worse after dinner. 

Silicea. — Vertigo accompanied by nausea, and aggravated by 
motion or by looking upward ; dizzy sensation from the nape 
of the neck into the head ; vertigo during sleep, or when rising 
from a recumbent position ; nervous or ocular vertigo, especially 
when brought on by severe physical or mental labor, reading, 
writing or sewing. 

Natrum sal. — Vertigo, with inclination to fall toward the left 
side ; labyrinthine vertigo, with tendency to fall to the affected 
side, while surrounding objects appear to move in the opposite 
direction; noises in the affected ear, with defective hearing; 
worse on raising the head or sitting up. 

Natrum carb. — Vertigo, with great lassitude; weakness of 
digestion, with nausea in the morning and inclination to 
vomit ; gastric and nervous vertigo, the latter from the effects of 
exposure to the sun. 

Lachesis. — Frequent momentary vertigo, especially on closing 
the eyes, sometimes with paleness, nausea and vomiting ; ver- 
tigo, with headache, cerebral congestion and cold extremities ; 
epileptic vertigo, with reeling, falling and loss of consciousness. 

Veratrum. — Vertigo, with sensation as if everything in the 
head was loose ; loss of appetite, with burning stomach, dis- 
tended abdomen, flatulency, vomiting and diarrhoea ; gastric 
vertigo, with cold perspiration on the forehead. 

Senega. — Ocular vertigo, especially when caused by paresis or 
paralysis of the superior rectus or superior oblique muscle of 
the eye, or when the vertigo and double vision are relieved by 
bending the head backward. 

. Ignatia. — Vertigo followed by nausea and vomiting of slimy, 
sourish fluid ; burning in the stomach ; abdominal distension, 
with flatulency and constipation ; restless, changeable disposi- 
tion ; vertigo caused by mental emotion ; gastric, nervous or 
epileptic vertigo ; worse from stooping or moving the head. 

Cuprum. — Vertigo when looking up, with loss of sight, as if 
gauze were before the eyes ; vertigo, with sensation of turning 
round, or revolving vertigo; vertigo from cerebral congestion; 
extreme weakness, especially of the lower extremities ; ocular 
vertigo caused by paralysis of the nervus abducentis. 



226 NERVOUS THERAPEUTICS. 

China. — Vertigo from nervous weakness or from general 
debility ; vertigo from anaemia, with pale face, ringing in the 
ears, nausea, vomiting or fainting; vertigo with an empty 
stomach ; gastric, nervous or auditory vertigo, especially when 
caused by debility from loss of animal fluids. 

Chininum sulph. — Vertigo occurring periodically, with chills 
and fever, especially when due to malarious influence; vertigo, 
with headache, cerebral congestion and deafness ; auditory ver- 
tigo, with hammering and humming in the ears and partial 
deafness. 

Conium. — Vertigo caused by looking steadily at an object, or 
on rising up or going down stairs, or when lying down or 
turning over in bed ; great debility and inclination to sleep ; 
ocular or auditory vertigo, with sensation as if turning in a 
circle. 

Arsenicum. — Vertigo, with inclination to fall, especially when 
closing the eyes ; nausea and disposition to vomit in a recum- 
bent position, less when sitting up ; burning in the stomach, 
with vomiting ; vertigo coming on periodically, with coldness, 
followed by fever, loss of appetite and vomiting ; gastric, nerv- 
ous or epileptic vertigo, with reeling, as if intoxicated. 

Bryonia. — Gastric vertigo, with nausea and disposition to 
faint; weakness and distension of the stomach, flatulence and 
constipation ; burning in the stomach, with vomiting ; aggra- 
vated by rising from a recumbent position and by motion ; 
ameliorated by rest and by lying down. 

Apomorphia. — Labyrinthine or gastric vertigo, attended with 
tinnitus and slight deafness ; nausea, with retching and vomit- 
ing, coming on at intervals ; sudden vomiting, almost without 
nausea ; syncope, with lessening of blood pressure. 

Belladonna. — Vertigo accompanied by luminous vibrations 
before the eyes, especially when stooping or bending the head ; 
vertigo, with vanishing of sight, and a tendency to fall back- 
ward or to the left side; epileptic vertigo, caused by rush of 
blood to the head, with heat and redness of the face, buzzing 
in the ears, dimness of vision and loss of consciousness; aggra- 
vated in a warm room ; ameliorated in the open air. 

Euphrasia. — Ocular vertigo from paralysis of the ocular mus- 



VERTIGO. 227 

cles, especially when caused by taking cold, or when associated 
with coryza ; blurring of the eyes, relieved by winking. 

Stramonium. — Vertigo followed by stupefaction of all the 
senses and by complete insensibility ; vertigo accompanied by 
strange fancies ; epileptic vertigo, especially when walking in the 
dark, day or night. 

Opium. — Vertigo, with stupefaction of the senses, or after 
fright ; vertigo, with apoplectic symptoms ; pale or bloated 
face, with dimness of sight and tendency to faint; ameliorated 
by rest; ocular vertigo, depending on paralysis of the accommo- 
dation. 

Tarantula. — Vertigo after breakfast, with a bad taste in the 
mouth ; vertigo from fixing the sight on any object ; gastric, 
nervous or epileptic vertigo, so severe as to cause him to fall, but 
without losing consciousness ; nausea, bloating of the stomach 
and disposition to vomit. 

Sepia. — Vertigo, with flatulency and constipation ; worse 
when drinking, while looking upward, or while looking from 
a great height, a large assemblage of people or an extended 
plain ; gastric or nervous vertigo, especially when caused by a 
dyspeptic condition ; worse when drinking. 

Hyoscyamus. — Epileptic or ocular vertigo, with reeling, loss of 
sight, hearing and consciousness ; double vision ; red, spark- 
ling, staring and distorted eyes. 

Kali iod. — Ocular vertigo, especially in syphilitic patients; 
dimness of vision, with twitching of the eyeballs ; burning in 
the eyes, with sensation of a film before the eyes, relieved by 
winking ; glandular swellings on neck. 

Cocculus. — Vertigo aggravated by noise, motion, smoking, cof- 
fee, sitting up in bed and riding in a carriage; epileptic vertigo, 
with nausea, reeling, loss of consciousness and sudden falling 
to the ground. 

Argentum nit. — Ocular vertigo, caused by weakness or paraly- 
sis of the ciliary muscle ; transitory blindness, nausea and con- 
fusion of the senses; sensation of expansion when looking high 
up in the street ; trembling weakness when walking with shut 
eyes, or *when walking in streets with high houses, as though 
they would fall upon him. 



228 NERVOUS THERAPEUTICS. 

Cicuta. — Auditory vertigo, associated with aural disease, dis- 
charge of blood from the ears, loud sounds when swallowing,, 
and hardness of hearing ; tinnitus aurium ; worse in the room 
than in the open air. 

Ipecacuanha. — Vertigo, with loss of appetite, empty retching- 
and qualmishness ; gastric vertigo, with nausea and vomiting ; 
abdominal distension, with flatulency, colic and diarrhoea. 

Colchicum. — Vertigo, with roaring and stoppage of the ears ; 
ameliorated by rest ; auditory vertigo, with chronic discharge 
from the ears and hardness of hearing. 

Kalmia. — Vertigo while stooping or looking downward ; pal- 
pitation of the heart ; auditory vertigo, with sensation when 
turning as of something loose in the head. 

Natrum mur. — Vertigo, with nausea and heartburn after eat- 
ing ; gastric vertigo, with reeling and dimness of sight ; sensa- 
tion of everything turning in a circle when walking ; nausea 
and sudden sinking of strength ; burning and feeling of press- 
ure in the stomach ; want of appetite and aversion to food. 

Physostigma. — Ocular vertigo from partial or complete paraly- 
sis of the ciliary muscle ; has been applied with benefit as a 
local application in such cases. 

Sulphur. — Chronic vertigo, especially if preceded by a sup- 
pressed eruption ; gastric vertigo, especially in the morning 
after breakfast, with nausea ; dimness of vision, with inclina- 
tion to fall to the left. 

Phosphoric ac. — Vertigo, with great disposition to sweat dur- 
ing the day; night-sweats, with vertigo; vertigo from onanism,, 
loss of animal fluids, or mental exertion, anxiety or over- 
work ; nervous vertigo, especially when caused by cerebral or 
nervous exhaustion. 

Gelsemium. — Vertigo, with reeling and staggering even to 
falling; heaviness of the head, with imperfection of sight and 
dulness of mind; ocular or nervous vertigo, the former from 
paralysis of the ocular muscles ; aggravated by smoking. 

Causticum. — Ocular vertigo caused by paralysis of any of the 
ocular muscles; congestion of blood to the head, with heat; 
vertigo brought on by taking cold ; sudden and frequent loss of 
sight, with sensation of a film before the e} T es ; inclination on 



COMA BOMNOLEKTUM. 229 

stooping to fall backward, and on looking up to fall toward 
the left side. 

Amyl nit. — Vertigo, with sensation as if a vapor spread from 
her through her head, rendering her powerless; slight nausea, 
with uncomfortable feeling in the stomach ; precordial anxiety ; 
she turned deadly pale, felt very giddy, then became partially 
unconscious, remaining so for ten minutes; mental confusion 
and a dreamlike state; auditory vertigo, with a bursting sensa- 
tion in the ears, as if the drums would be forced out with each 
beat of the heart; great throbbing in the ears and head, with 
confusion. 

Calcarea carb. — Vertigo, with stupefaction of the head; sensa- 
tion of coldness in the brain; vertigo, with tinnitus and 
nausea, especially when stooping or rising up suddenly ; ver- 
tigo caused by cerebral congestion : distension of the stomach 
and bowels, flatulence and constipation; gastric or epileptic 
vertigo. 

Aconite. — Vertigo on raising the head, or on rising from a 
recumbent position ; vertigo, with sensation of intoxication, the 
patient staggering like a drunken man; nausea; great fear of 
falling; auditory vertigo, with reeling; ivorse when bending 
forward or going down stairs. 

Compare, also, Graphites, Iodium, Chamomilla, Bovista, Cy- 
clamen, Ruta, Mezereum, Lycopodium, Secale, Platina, San- 
guinaria, Thuja, Staphisagria, Tartar em., Mercurius, Hepar, 
Coffea, Boracis, Arnica, Spongia, Asterias rub., Agaricus, Sam- 
bucus, Theridium, Spigelia, Apis. 

Auxiliary Treatment. — The application of the galvanic 
current is usually of great service in all forms of vertigo, either 
as central galvanization, or by the application of both poles on 
each side of the sixth and seventh cervical vertebra?, using 
from ten to fifteen cells, as the case may require. 

COMA SOMNOLENTUM. 

Synonyms. — Stupor, Sopor, Somnolency, Lethargy, Carus, 
Somnolentia, Lethargia, Carus Lethargus ; Fr., Stupeur ; Ger., 
Stumpfsinn. 



230 NERVOUS THERAPEUTICS. 

Definition. — A greater or less degree of insensibility, arising 
from a partial or complete loss of consciousness, due to an 
abnormal amount and kind of sleep. 

Diagnosis. — It is not always easy to distinguish the various 
degrees of insensibility, or unconsciousness, due to abnormal 
sleep, from similar conditions resulting from other causes. 
For example, coma is a state of complete insensibility, but 
complete insensibility is not always coma, and the same is true 
of minor degrees of unconsciousness. As a general rule, how- 
ever, we will find, in addition to the comatose state, certain 
characteristic symptoms belonging to the primary affection, 
the presence of which will serve to distinguish the condition 
from that of simple coma. Thus in syncope there is fainting ; 
in asphyxia, deficient respiration; in narcosis, the peculiar 
effects of the agent or drug producing it ; and in uraemia, con- 
vulsive movements, vomiting, etc. 

Pathology. — Natural sleep is a physiological, not a patho- 
logical condition ; but stupor, lethargy, coma, etc., denote 
different degrees of insensibility somewhat allied to sleep, but 
in which the loss of consciousness is more profound than in 
any form of true sleep. The terms stupor, sopor, lethargy, etc., 
are employed to designate various degrees of insensibility and 
unconsciousness from that of sleep properly so called, up to 
that of profound anaesthesia, in which there is complete loss of 
consciousness and true coma. Not only does stupor vary in 
degree, but coma also. Thus we have what is known as the 
comatose state, coma and profound coma, the last of which was 
designated by the older writers cams, the gravest of the graver 
states of unconsciousness and insensibility. These are all 
pathological conditions or, rather, symptoms of such conditions, 
the pathology of which corresponds with that of the primary 
diseases to which the symptoms belong. 

Clinical Experience. — The chief clinical distinctions are 
as follows : 

For stupor manifesting itself in the morning: Nux vom., Natrum, 
Hepar, Phosphoric ac, Sulphur, Natrum mur. 

For somnolency coming on early in the evening : Pulsatilla, 
Lachesis, Calcarea, Silicea, Phosphoric ac, Nux vom. 



COMA SOMNOLENTUM. 231 

For coma somnolentum: Belladonna, Opium, Laurocerasus, 
Barium carb., Crocus, Ledum, Veratrum. 

For profound coma: Opium, Belladonna, Lachesis, Lyco- 
podium. 

Therapeutic Indications. — Bryonia. — Moanings and start- 
ings in sleep, with fever, and sometimes with loud cries; great 
drowsiness or heavy stupor, with or without delirium. 

Pulsatilla. — Deep sleep, with snoring inspirations ; charac- 
teristic symptoms, cerebral, gastric, intestinal and urinary; 
valuable in cases complicated with erysipelas. 

Veratrum. — Protracted stupor, especially when accompanying 
the collapse of diarrhoea or cholera ; coldness of the whole body. 

Stramonium. — Deep sleep, with stertorous respiration and 
bloody froth at the mouth ; epileptic coma. 

Belladonna. — One of the most reliable remedies for stupor 
arising from cerebral congestion ; stupor, with snoring, dark 
red face, dilated pupils ; drowsy, yet unable to sleep ; delirious 
sleep ; eyes half open, but insensible to light. 

Lachesis. — Comatose symptoms, especially when resulting 
from erysipelas of the head and face; constant sopor, with 
moaning and tossing about, especially in children. 

Rhus tox. — Especially valuable in the coma of typhoid fever 
and erysipelas; sopor, with snoring, muttering and grasping at 
flocks. 

Opium. — Profound coma, such as occurs in apoplexy, with 
stertorous breathing, dilated pupils, dark red, bloated face, and 
feeble, irregular pulse; mouth open, eyes half closed, pupils 
insensible to light. 

Chamomilla. — Soporose condition in children, with feverish 
restlessness ; snoring and starting in the sleep ; delirium, with 
moaning, talking or screaming ; comatose condition during 
dentition, especially w T hen associated with diarrhoea. 

Tartar emet. — Coma, with constant yawning and stretching ; 
especially indicated w T hen the symptom" is caused by irritation 
or congestion of the brain ; great prostration, with trembling 
of the limbs ; coma of delirium tremens. 

Camphora. — Sopor and delirium, with chilliness and coldness 
of the body ; talking and snoring in the sleep ; cerebral con- 
gestion ; face red, but sometimes pale. 



232 NERVOUS THERAPEUTICS. 

Phosphoric ac. — Sopor, especially in the daytime ; being 
roused, lie answers correctly, but immediately falls asleep 
again ; typhoid fever, especially when attended by profuse 
sweating. 

Helleborus. — Sopor, especially when resulting from an attack 
of hydrocephalus, either acute or chronic; fever, with hot head 
.and cold hands and feet ; urine suppressed. 

Secale cor. — Long-continued stupor, with startings and de- 
lirium; cold, viscid sweat; face red or pale ; foetid and colliqua- 
tive diarrhoea ; suppression of urine. 

Nux mosch. — Sopor, with or without delirium ; valuable in 
low forms of fever, especially when accompanied by putrid or 
colliquative diarrhoea; also in children during the diarrhoea 
of teething. 

Lycopodium. — Very drowsy during the day, with yawning ; 
sleep disturbed by loud screams ; starting and jerking of the 
limbs during sleep ; great nervous irritation, with peevish 
mood; fevers. 

Compare, also, Ignatia, Arsenicum, Cuprum, Sepia, Arnica, 
Carbo veg., Ledum, Conium, Capsicum, Alumina, Colocynth, 
Crocus, Sambucus, Antimonium, Cannabis, Hydrocyanic ac, 
Lactuca and Asafoetida. 

INSOMNIA. 

Synonyms. — Sleeplessness, Wakefulness, Pervigilium ; Ft., 
Insomnie; Ger., Schlaflosigkeit. 

Definition. — An unnatural deficiency or loss of sleep. 

Diagnosis. — Healthy sleep varies within certain limits in 
different individuals; and this variation is occasionally so 
great, that what would be a normal amount of sleep in one 
would constitute an excess or a deficiency of sleep in another. 
The diagnosis therefore must be based on the average or nor- 
mal habit of the patient himself, and not on that of others. 

Pathology. — As in other symptomatic affections,. insomnia 
is a mere symptom of some other abnormal condition or dis- 
ease. It may be partial, as when the patient is able to obtain 
only a portion of his usual allowance of sleep ; or it may be 



INSOMNIA. 233 

complete, in which case he may be unable to obtain any sleep 
whatever for several successive nights, as in acute mania, 
violent fevers, or when suffering from severe pain, profound 
grief or great mental disturbance. In these cases the primary 
disease is the one to be chiefly considered. 

Clinical Experience. — In the absence of other indications, 
the following clinical distinctions will be of service : 

Sleeplessness before midnight. — Passiflora incar., Gelsemium, 
Belladonna, Mercurius, Phosphorus, China, Ignatia, Pulsatilla, 
Spigelia, Graphites, Valerian, Conium, Carbo veg., Calcarea 
carb., Sulphur, Bryonia, Cyclamen, Selenium, Moschus, Staph- 
isagria, Aconite, Opium. 

Sleeplessness after midnight. — Passiflora, Rhododendron, Asa- 
fcetida, Platina, Rhus tox., Mercurius, Arsenicum, Coffea, He- 
par, Nux vom., Kali carb., Aurum, Nitric ac, Thuja, Hyoscy- 
amus, Sambucus, Capsicum. 

Waking frequently. — Passiflora, Gelsemium, Belladonna, 
China, Fluoric ac, Teucrium, Manganese, Digitalis, Bismuth, 
Causticum, Calcarea carb., Nux vom., Pulsatilla, Phosphorus 
Zincum, xlrnica, Rhus tox., Nitric ac. 

Waking too early. — Ranunculus bulb., Muriatic ac, Dulca- 
mara, Sepia, Asafcetida, Phosphoric ac, Silicea, Natrum carb. 

Retarded sleep. — Passiflora, Gelsemium, Belladonna, Pulsa- 
tilla, Nux vom., China, Ignatia, Sepia, Causticum, Graphites, 
Phosphorus, Selenium, Lachesis, Carbo veg., Caladium, Mer- 
curius, Rhus tox., Sulphur, Creosotum, Aconite, Moschus, 
Opium, Veratrum vir. 

Therapeutic Indications. — Passiflora incar. — Sleeplessness, 
with great restlessness; suicidal mania; neuralgia, preventing 
sleep. This is one of the most reliable remedies for insomnia, 
the patient falling into a quiet slumber, from which he usually 
awakes in a natural and rational condition. 

Gelsemium. — Drowsy and sleepless, or else w 7 ide awake and 
unable to get to sleep ; insomnia from cerebral irritation and 
congestion ; insomnia from overwork or debauch ; insomnia 
of college professors, authors or business men. 

Belladonna. — Insomnia, with drowsiness; cerebral congestion. 
One of the most reliable remedies for insomnia when properly 
16 



234 NERVOUS THERAPEUTICS. 

given, the higher potencies being required in all cases where 
the brain is oversupplied with blood or actively congested, 
and the lower ones when it is overpowered by the intensity 
of blood pressure, pupils widely dilated and convulsions 
threatened. 

Aconite. — Sleeplessness from febrile and inflammatory condi- 
tions; anxiety, with great restlessness and tossing about; sleep- 
lessness of infants and aged people; sleeplessness due to mental 
excitement, especially when there is active cerebral congestion, 
with intense anxiety and fear of death or disaster. 

Cimicifuga. — Sleeplessness associated with pain in the base of 
the brain, extending to the nape of the neck, and sometimes 
over the shoulders ; extreme prostration, both physical and 
mental. An invaluable remedy in the insomnia of drunkards, 
especially when it takes the form of delirium tremens, and also 
in that of opium-eaters, or those who are tr} r ing to abandon 
the use of it. 

Nux vom. — Sleeplessness from overwork, both mental and 
bodily ; too close study, especially at night ; abuse of stimu- 
lants; especially useful in cases of recent debauchery and 
gluttony. 

Phosphorus. — Gets to sleep too late or not at all; insomnia 
from nervous debility, especially when caused by onanism or 
sexual excesses ; sleeplessness following intense mental strain, 
overwork or anxiety, or when associated with pain and con- 
fusion in the head ; wakens frequently during the night, and 
can get no sound and refreshing sleep. 

Opium. — Great wakefulness or drowsiness, with inability to 
get to sleep ; insomnia, with acuteness of hearing, the ticking 
and striking of the clock, cock-crowing and other noises keep- 
ing the patient awake. This remedy, used somewhat high, also 
mitigates the stupor of cerebral congestion, especially where 
there is a tendency to apoplexy; particularly suited to the 
sleeplessness of old people. 

Veratrum vir. — Sleeplessness from cerebral congestion, or 
from a general febrile condition; particularly useful in the 
insomnia of acute fevers, puerperal mania and the excitement 
attending attacks of epilepsy. 



INSOMNIA. 235 

Hyoscyamus. — Sleepless from nervous excitement; wild, star- 
ing eyes ; tendency to delirium ; especially suited to nervous 
and overworked persons, particularly women suffering from 
undue lactation, household cares, etc. 

Ignatia. — Sleepless from grief or depressing emotions; in- 
somnia caused by nervous exhaustion, loss of health, property 
or friends. 

Pulsatilla.— Sleeplessness arising from late suppers or from 
indigestion ; determination of blood to the head and surface of 
the body, rendering the patient restless, sleepless and very 
uncomfortable ; particularly suited to insomnia occurring in 
mild and tearful young women, especially if there happens to 
be any derangement of the menstrual function. 

Coccnlus. — Sleeplessness arising from mental activity or from 
night-watching ; sleep retarded, and frequently interrupted by 
wakings and starlings. 

Zincum val. — Insomnia, with pains in the head, particularly 
in children ; frequent waking in the night ; drowsy, with pale 
and tired expression of countenance. 

Coffea. — Sleeplessness of infants ; sleeplessness arising from 
joy, long watching and overexcitement of mind ; acute nerv- 
ous erethism, preventing sleep. 

Moschus. — Nervous excitement preventing sleejD ; is awakened 
by sense of heat, rendering the covering uncomfortable ; re- 
lieved by throwing off the covering. 

Stramonium. — Sleepless from intense nervous excitement; 
sleep interrupted by frightful screams; restless sleep full of 
dreams : tendency to delirium ; best suited to cases attended 
with unusual mental disturbances, or where there is a tendency 
to maniacal excitement. 

Silicea. — Sleeplessness arising from extreme physical and 
mental prostration; great depression of spirits; sleeplessness 
from inanition. 

Coca. — Sleeplessness from mental exhaustion or from anae- 
mia; patient sometimes awakened after going to sleep by a 
sense of shock in the brain ; suited to weak and nervous women, 
worn-out brain-workers, night-watchers and those who have 
lost much sleep. 



236 NERVOUS THERAPEUTICS. 

Sulphur. — Sleepless from nervous excitement, cutaneous irri- 
tation and external heat; sleepy in daytime, sleepless at night. 

Arsenicum. — Insomnia from nervous exhaustion caused by 
general anaemia ; will seldom benefit cases not due to blood 
degeneration, and hence must be given with a view of over- 
coming this condition. 

Auxiliary Treatment. — The three principal causes of 
sleeplessness are, imperfect circulation, indigestion and anaemia. 
Much may be done in the way of accessory treatment to remedy 
these difficulties, and thus secure sound sleep. Thus imperfect 
circulation, whether it take the form of cerebral hyperemia, 
cold feet, or both combined, as is usually the case, may be cor- 
rected by a warm bath or by a brisk rubbing just previous to 
retiring for the night. Sometimes a cold douche just after the 
bath will be still more effective. Massage and gymnastic exer- 
cises are also useful for the same purpose, though as a general 
rule the latter had best be practiced in the morning, unless 
the patient leads a sedentary life, in which case the evening 
practice is the most suitable. 

The effects of indigestion in preventing sleep may usually 
be remedied by partaking of very early and very light suppers, 
but this is a matter in which every individual is a law unto 
himself; experience alone can determine what form, character 
and amount of food will best agree with any one patient, and 
the same is true as to the time of eating. 

Sleeplessness arising from general anaemia may be success- 
fully combated by the administration of liquid food, such as 
hot milk, beef-tea and broths, an hour or so before bedtime. 
In these cases, also, the patient should sleep with his head 
low, whereas in cases of hyperaemia the head should be well 
elevated. 

As for the bed, the bed-clothing, etc., the aim should be to 
secure perfect comfort to the patient. No part of the body 
should be chilled, nor should any portion of it be overheated. 
Plenty of fresh air should be supplied to the sleeping room, 
while at the same time the sleeper should be protected from 
draughts, even moderate ones, as they always have a tendency 
to disturb the circulation, which is inimical to sound sleep. 



F»ART VII. 

MENTAL DISEASES. 

MELANCHOLIA. 

Synonyms. — Melancholy ; Fr., Lypemanie, Melancolie ; Ger. f 
ScJt wermuth, Melancholie. 

Definition. — A form of mental alienation, characterized by 
excessive gloom, despondency and. apprehension. 

Diagnosis. — Although formerly regarded as a species of 
monomania, or partial insanity, it may be distinguished from 
it by the fact that there is in simple melancholy little or no 
disorder of the intellect, the emotion is disproportioned to the 
cause, and hence there is often associated with it a suicidal 
tendency. But melancholy with delusions, constituting hypo- 
chondriasis, is most frequently met with, and is the form we 
are usually called upon to treat (see hypochondriasis). 

Pathology. — The physical state with which nearly all cases 
of melancholia are associated is one of anaemia, but just what 
relation the anaemia sustains to the mental condition is not 
fully determined. We know that powerful moral emotions, 
associated with great mental depression, will, if long con- 
tinued, derange the bodily functions and lead to inanition 
and exhaustion. On the other hand, when, as in these cases, 
there is a strong predisposition to the disease, there is no 
doubt that defective blood nutrition affords a sufficient ex- 
planation of simple melancholy, which is a state of mere 
depression. 

Clinical Experience. — The remedies of greatest repute in 
melancholia are : Aurum, Ignatia, Arsenicum, Kali phos., Lyco- 
podium, Pulsatilla, Nux vom., Belladonna, Natrum mur., Cimi- 
cifuga, Phosphorus, Platina, Ambra, Plumbum, Iodium, Kali 
brom., Agnus cast, Amyl nit. and Veratrum. 

(237) 



238 NERVOUS THERAPEUTICS. 

Therapeutic Indications. — Aurum. — Extreme melancholy, 
fearful, taciturn, mistrustful ; suicidal tendency, has a great loath- 
ing of life ; ansemia, vertigo, vascular and nervous depression ; 
hypochondriasis ; religious melancholy. 

Ignatia. — Silent grief; desires solitude that he may nourish 
his sorrow ; aversion to every form of amusement ; anxiety, 
with taciturnity ; sexual impotency ; hypochondriasis. 

Arsenicum. — Very despondent ; does not wish to recover, as 
she thinks she is in the way, and her family would be better 
off without her ; poor appetite ; says she is getting weak and 
cannot control her mind ; tongue red; has an intense desire for 
small quantities of water at short intervals; persistent burning 
pains in the stomach and bowels ; hypochondriasis. 

Kali phos. — Melancholic, depressed mood, with excitement 
and sleeplessness; no appetite; weeps a great deal from religious 
melancholy ; constant lamentations, self-reproaches and crying; 
staring, unconscious look ; irritable, fretful, timid, distrustful, 
weeping mood, with disgust of life and fear of death ; hypo- 
chondriasis. 

Lycopodium. — Weeps the whole day; cannot calm herself; 
worse from 4 till 8 o'clock p.m. ; full of ungrounded fears ; 
pusillanimous. 

Pulsatilla. — Religious melancholy ; greatly concerned about his 
worldly and eternal well-being ; weeps, prays and laments ; early 
in the morning, depression of spirits and full of cares about 
domestic affairs; pale face, cold hands, flushes of heat; pre- 
cordial anguish, with thoughts of suicide. 

Nux vom. — Taciturn and fond of solitude ; easily vexed and 
disposed to quarrel with every one; afraid of coming to want; 
has a kind of fainting feeling, with nausea and flushes of heat, 
going off when lying down ; pale, sunken countenance ; lack 
of appetite, slow pulse and constipation ; involuntary sighing 
and moaning ; hypochondriasis. 

Belladonna. — Cerebral congestion; restlessness which drives 
him from place to place, and will not allow him to sit or lie 
down for more than a few minutes at a time ; full of mistrust 
and apprehension; starts easily; extremely low-spirited, with 
disposition to take his own life ; great irritability, with mental 
anguish. 



MELANCHOLIA. 239 

Natrum mur. — Excessive despondency ; fnll of gloomy 
thoughts; will not listen to consolation; likes to dwell on past 
unpleasant occurrences; sallow complexion ; loses flesh, though 
living well ; hypochondriasis. 

Cimicifuga. — Puerperal melancholy ; imagines the whole world 
is against her and that she will become insane; cries, sobs, 
feels perfectly helpless, and believes her case is beyond medical 
skill ; puerperal hypochondriasis ; bowels costive, tongue furred, 
spine sensitive to pressure. 

Phosphorus. — Extreme melancholy ; gloomy, taciturn, anxious, 
discontented and irresolute ; loathing of life, but anxious for the 
future; cold feet and hands, with trembling of the limbs; 
frequent empty eructations ; constipation ; impotence.- 

Platina. — Melancholy, with dread of death ; weeping mood ; 
anorexia; anxiety, with trembling; disorder of the sexual 
system. 

Ambra gris. — Extreme depression of spirits; sits day after 
day weeping, with great muscular debility and pain in small 
of the back ; feels ivorse from the presence of other people ; sleep- 
less and constipated. 

Plumbum. — Religious melancholy ; great weakness of the sexual 
organs ; extreme constipation ; frequent attacks of colic ; restless, 
hopeless and indifferent to everything. 

Iodium. — Melancholy and discouraged ; has no ambition ; 
wishes to be left alone; shuns every one, especially the 
physician; is very apprehensive, restless and thinks that he 
will become insane. 

Kali brom. — Mental depression from cerebral exhaustion; 
suicidal tendency; religious melancholy, with sense of moral 
unworthiness ; nervous system all unstrung ; sheds tears and 
gives w T ay to her feelings in a childish manner ; indifferent to 
life. 

Agnus cast— Extremely low-spirited, with sense of approach- 
ing death ; vertigo, with loss of memory ; starts in sleep, as if 
from fright ; great physical debility, with prostration of mind 
and body ; puerperal melancholy. 

Amyl nit. — Coldness and chilliness, followed by fever ; great 
depression of spirits, with heat of head and burning of the 



240 NERVOUS THERAPEUTICS. 

hands and feet'; features contracted, face pale, eyes lustreless, 
and mind dull and obtuse. This remedy is best administered 
by inhalation, two or three drops, on cotton, three or four 
times a day. 

Veratrum. — Great anxiety, despondency and despair; religious 
melancholy ; distrusts every one ; cold sweat all over ; moaning 
during sleep ; frightful dreams ; fearfulness, with tendency to 
start at every new sight or person ; frequent eructations ; 
puerperal melancholia. 

Compare, also, Helleborus, Cannabis ind., Abrotanum, Colocynth, 
Lachesis, Indigo, Stramonium, Bromine, Lithium, Kali iod., 
Lobelia, Sulphur, Leptandra, Hepar, Causticum, Calcarea, Alumina 
and Hyoscyamus. 

Auxiliary Treatment. — This may be summarized as fol- 
lows : (1) Rest as a means of mental and physical recupera- 
tion; (2) exercise, amusement and occupation as stimulants 
in the renewal of health ; (3) nourishing diet and, where 
necessary, artificial feeding ; (4) sanitary hygiene, including 
the warm bath, massage, etc. ; and (5) mental and moral 
hygiene, especially such as is calculated to divert the mind of 
the patient from his own troubles, furnish an adequate motive 
for his exertions and, at the same time, produce little or no 
fatigue ; in short, the chief aim should be to impart vigor of 
body and cheerfulness of spirit to the patient, not only in the 
ways above mentioned, but, if necessary, by change of scene, 
travel, cheerful society, and such other measures as the exigen- 
cies of the case may require. 

HYPOCHONDRIASIS. 

Synonyms. — Hypo, Spleen, Morbus Hypochondriacus; Fr.> 
Hypochondrie ; Ger., Milzhrankheit, Milzsucht. 

Definition. — A form of melancholia, characterized by hallu- 
cinations relative to the state of the patient's physical health. 

Diagnosis. — The diagnosis between hypochondriasis and 
simple melancholy is usually evident enough, since the pecu- 
liar hallucination which characterizes the former is always 
absent in the latter. Moreover, in the former there is no ten- 



MORAL INSANITY. 241 

dency to suicide. On the contrary, the chief concern of the 
patient has regard to the prolongation of his life, and this 
impels him to endless search for the cure of his ailments, 
whether real or imaginary. 

Pathology. — As there are no anatomical characters peculiar 
to the disease, the pathology does not essentially differ from 
that of simple melancholia, which see. 

Treatment. — See previous section, as the clinical experience, 
therapeutic indications and accessory treatment given under 
the head of melancholia apply equally to hypochondriasis, 
which is but a special form of melancholy. 

MORAL INSANITY. 

Synonyms. — Emotional Insanity, Impulsive or Affective 
Insanity ; Fr., Manie sans Delire, Folie Baisonnante, Monomanie 
Affective; Ger., Gemilthswahnsinn. 

Definition. — A species of insanity in which the intellect is 
apparently unimpaired, but the moral and emotional part of 
the brain is disordered. 

Diagnosis. — Moral insanity differs from every other form 
of the disease in the absence of delusion. Notwithstanding this, 
the morally insane can scarcely be considered of sound intel- 
lect, as their conduct is not only odd, peculiar and unlike that 
of other people, but is often foolish and very unwise, the 
patient, for example, spending his capital as if it were income, 
or approving acts which admit of no justification. 

Another diagnostic point is, that they seldom, if ever, are 
insane on more than one point. If, for example, they are pos- 
sessed of a suicidal tendency, they have no desire to kill others; 
if they have a propensity to steal, they have no disposition to 
commit acts of violence; in other words, they are true mono- 
maniacs. 

Pathology. — Whether caused by hereditary transmission, 
as is usually the case, or by physical disease, there is in both 
instances some abnormal condition of the moral portion of the 
nervous centre. Pathology shows that, as the intellectual 
functions are not materially disturbed, the disease must be 



242 NERVOUS THERAPEUTICS. 

seated in the cells of the cortical portion of either the lateral 
and posterior portions of the cerebrum, or in those of the cor- 
tical portion of the cerebellum and medulla oblongata. The 
former is probably the true seat of the malady, as disease or 
irritation occurring in the cerebellum and medulla oblongata 
produces a want of controlling power over the muscles, and 
not over the mind. 

Clinical Experience. — The homoeopathic materia medica 
is exceedingly rich in emotional remedies, but we shall merely 
indicate here a few of those which experience has shown can 
generally be relied upon to meet the special symptoms that 
characterize the most common forms of emotional insanity. 

For angry mood: Nux vom., Ignatia, Bryonia, Arsenicum, 
Veratrum, Staphisagria. 

For quarrelsome disposition : Calcarea, Aconite, Chamomilla, 
Ignatia, Lycopodium, Coffea, Aurum, Nux vom., Alumina. 

For malice: Belladonna, Lycopodium, Stramonium, Verat- 
rum, Hyoscyamus, Nux vom. 

For jealousy : Hyoscyamus, Lachesis, Pulsatilla, Causticum, 
Cicuta, Baryta. 

For audacity : Ignatia, Aconite, Opium, Pulsatilla, Berberis. 

For vindictiveness : Aurum, Agaricus, Lachesis, Anacardium. 

For artfulness : Nux vom., Lachesis, Chlorum, Drosera, Coca. 

For obstinacy : Belladonna, Sulphur, Ignatia, Silicea, Lyco- 
podium, Calcarea, Nitric ac. 

For greediness : Bryonia, Sepia, Arsenicum, Pulsatilla, Lyco- 
podium, Calcarea, Natrum carb. 

For fitful mood: Ignatia, Platina, Sulphuric ac, Aconite, 
Belladonna, Graphites, Zincum. 

For suicidal disposition: Aurum, Arsenicum, Belladonna, 
Antimonium crud., Pulsatilla, Nux vom., Derris pin. 

For disposition to hill : Stramonium, Arsenicum, Hepar, China, 
Lachesis. 

For disposition to commit acts of violence : Belladonna, Stra- 
monium, Hyoscyamus, Veratrum, Cocculus, Platina, Cuprum, 
Lycopodium. 

Therapeutic Indications. — See melancholia and mania for 
both indications and auxiliary treatment. 



MANIA. 243 



MANIA. 



Synonyms. — Madness, Insanity, Furor Mania; Fr., Farcur, 
Manie Aigue; Ger., Tobsucht, Wuth, Tollheit. 

Definition. — Disorder of the intellect, characterized by 
hallucinations or delusions which impel to acts of violence. 

Diagnosis. — The violence which characterizes acute mania 
is such as to prevent any error of diagnosis in cases of that 
character; but there are many varieties of simple mania, aris- 
ing from numerous causes, in which the excitement is not very 
great, nor the delusions, if any, very manifest, especially in 
the early stages ; but they are all attended by more or less 
excitement, there is no gloom or depression, the conduct is 
more or less noisy and irrational, and, sooner or later, de- 
lusions, coinciding with the temper and bodily condition, 
manifest themselves. Moreover, the will-power is usually 
more or less impaired, perception, reason and volition are all 
to a greater or less extent defective, and if any motive actuates 
the patient, there is such a want of correspondence between it 
and the act that there cannot be said to be any adequate mo- 
tive for it. 

Pathology. — The physical changes in the brain which char- 
acterize insanity are best seen in chronic cases, where we find 
degeneration of the cerebral nerve-cells, producing condensa- 
tion and atrophy of the gray substance, increased weight, di- 
minished volume and chronic inflammation, with softening. 
Now, although such changes are not observed to any such ex- 
tent in acute cases, it cannot be doubted that material altera- 
tions do exist in all cases of insanity, whether acute or chronic. 
Even with our inadequate means of demonstration, Balfour, 
who analyzed seven hundred post-mortems, found tissue alter- 
ations in ninety-one per cent, of his cases. Hence the con- 
census of opinion among alienists now is, that insanity is an 
actual morbid condition of the brain itself, and not a mere 
functional disturbance, as was once thought. Indeed, so evi- 
dent is this truth, that the eminent physiologist, Van der Kolk, 
asserts that he never failed to discover pathological changes 
where there was abnormal mental function manifested ; as, for 



244 NERVOUS THERAPEUTICS. 

example, where mania existed he found the cortical layer 
under the frontal bones darkened, more closely adherent to the 
pia mater, or softened. 

Clinical Experience. — Acute or Furious Mania. — Stramo- 
nium, Opium, Tarantula, Hysocyamus, Belladonna, Gelsemium, 
Cuprum. 

Suicidal Mania. — Aurum, Nux vom., Pulsatilla, Rhus tox., 
Belladonna, Sepia, Platina, Zincum, Carbo veg., Alumina, 
Mercurius, Staphisagria, China, Sulphur, Nitric ao, Arsen- 
icum. 

Religious Mania, — Stramonium, Baryta, Aurum, Crocus, 
Lachesis, Yeratrum. 

Mania, with Fear. — Aconite, Opium, Veratrum. 

Mania, with Aversion. — Conium, Aurum, Calcarea carb., Ci- 
cuta, Ammonium mur. 

Gay Mania, — Stramonium, Hyoscyamus, Belladonna, Au- 
rum, Platina, Crocus, Lycopodium, Yeratrum, Anacardium. 

Apathetic Mania. — Argentum, Antimonium crud., Coca. 

Antagonistic States of Mind. — Phosphorus, Anacardium, 
Staphisagria, Sepia, Capsicum. 

Puerperal Mania. — Platina, Cimicifuga, Belladonna, Pulsa- 
tilla, Ignatia, Aurum, Hyoscyamus. 

Therapeutic Indications — Stramonium. — Acute mania, char- 
acterized by furious rage ; gay mania, dances, gesticulates, 
laughs and sings, has paroxysms of constant talking, or breaks 
out into low laughter, or is in ecstasy, filled with pleasant 
fancies, expresses his wishes by signs, exceedingly busy with 
his fancy and quite cheerful ; religious mania, kneels down, 
stretches his hands out with pious look, starts up from the least 
opposition, with wild cries and violent gestures ; puerperal 
mania and nymphomania, with obscene gestures and language ; 
desires light and company, being afraid to go alone ; very 
loquacious, in a prayerful, beseeching, imploring language ; 
face often red and bloated. 

Opium. — Furious mania, with rage, fear, distortion of face, 
protruding and congested eyes, bluish redness and swelling of 
the lips; paroxysms of rage, with rolling on the floor and 
threats against his own relatives, whom he does not seem to 
recognize. 



MANIA. 245 

Hyoscyamus. — Acute and subacute mania, with or without de- 
lusions, where the patients are destructive, tearing up and 
breaking everything, and filthy in their habits; talks incessantly 
and does not sleep ; noisy, shouting and walking about inces- 
santly ; wants to go naked, will wear no clothes, tears them into 
tatters; hallucinations, but little or no cerebral congestion ; gay 
mania, dances, laughs in an absent manner, makes ridiculous 
gesticulations like a clown, and performs funny tricks like a 
monkey ; religious mania, alternately ludicrous, solemn or 
furious, dresses in some fantastic way, as in a priest's gown 
over his shirt with fur boots, wants to go to church in this 
guise in order to preach or officiate at mass, and ferociously at- 
tacks all who try to oppose him ; puerperal mania, thinks she 
has killed her child, and that her chin has become a duck's 
bill ; sleepless, unwilling to remain in bed, delirious, but not 
violent, or else furious, with indescribable rage and horrid an- 
guish ; does not know her own relatives ; complains of having 
been poisoned ; complete loss of modesty, throws off the bed- 
clothes ; hyperesthesia of cutaneous nerves ; melancholy, with 
muttering, starting and twitching. 

Belladonna. — Acute, subacute and chronic mania, with conges- 
tion of the brain, headache, flushed face, hallucinations, intol- 
erance of light and noise, desire to suicide by drowning ; 
chronic, with occasional exhibitions of silly laughing during 
agreeable intervals ; unsteadiness of purpose, with almost con- 
stant tendency to move some part of the body, especially the hands, 
indisposition to converse, especially with strangers, to whom she 
makes determined answers \ opposition excites rage and de- 
structive tendencies; walks hurriedly, sings, dances, laughs 
and waves her hands ; worse in the afternoon, evenings and 
at the approach of the menstrual period ; desire to bite, strike 
and run away ; gay mania, a merry craziness, with laughing and 
singing, tries to compose songs, and sings merry but senseless 
tunes, or whistles occasionally, but refuses to eat or drink, or 
sings or hums different airs, or smiles a long time to himself, 
or is disposed to sing or whistle, with frequent bursts of laugh- 
ter, or is wild and wantonly merry, with inclination to quarrel 
without cause, or will tear off clothes, run out into the street 



246 NERVOUS THERAPEUTICS. 

partially or wholly naked, gesticulating in a strange manner, 
crying, laughing, muttering and demanding foolish things ; 
suicidal mania, with distaste for life and desire for death ; 
wishes some one to kill him ; attempts to jump out of the 
window; alternating with paroxysms of fury ; puerperal mania, 
merry but quarrelsome ; strikes and bites ; starts in affright at 
the approach of others ; tries to escape or hide ; insomnia, fear 
of ghosts, moaning ; begs those around her to get her out of 
the way and kill her. 

Aurum. — Sleeplessness, anguish of mind, seems to have no 
friends ; fits of anger, rashness and fury ; desperate actions and 
thrashing about; speaks continually in questions and is quar- 
relsome ; great depression, with suicidal tendency ; suicidal 
mania, great desire to commit self-destruction, seeking every 
opportunity to do so ; excessive desire for water, with melan- 
choly notion that he was not intended for this world ; anxious 
desire to take his own life, attended with derangement and 
cramps in stomach and bowels ; religious mania, he imagines 
he is irretrievably lost, with desponding shouts and screams ; 
puerperal mania, with precordial anguish, driving her from place 
to place ; unhappy, with continual thoughts of suicide ; prays all 
the time ; imagines she is not fit for this world ; weak memory 
and intellect. 

Nux vom. — Obstinate and quarrelsome, increasing to violence; 
suicidal mania, desire for death, because his agony of mind 
allows him no repose, because present pain and misfortune 
seem insupportable to him ; inclined to take his own life, with 
palpitation of heart and great anxiety ; morose and taciturn ; 
disposed to quarrel if disturbed; giddiness, with reeling; con- 
stipation; gastric disturbances; nymphomania. 

Anacardium. — Sensation of being possessed of two opposing 
wills; is inclined to laugh when he ought to be serious, and 
does not incline to laugh when tempted by w T hat is ludicrous; 
actions stupid and childish ; rapid loss of self-reliance, memory 
and mental vigor; incipient dementia. 

Mercurius. — Insomnia, with peevishness, irritable temper, 
great restlessness, apathy, sensation as if the head would burst; 
suicidal mania, with disgust for life, from want of courage to 



MANIA. 247 

meet trials and mortification, or desire for death, from an in- 
supportable dislike for every person and thing, even those 
which are most loved. 

Aconite. — Acute mania, attended with fear, despondency and 
apprehensions of future calamity; anxious lamentations ac- 
companied by disheartening apprehensions; anxiety, attended 
with heat of the face and head, palpitation of the heart and 
coldness of the extremities; apprehensions of approaching 
death ; puerperal mania, with great fear of death; ailments from 
fright or anger ; fear of strangers, of not getting up ; inconsol- 
able anxiety; reproaching others for mere trifles. 

Gelsemium. — Acute mania, attended with cerebral congestion ; 
head hot, face flushed, eyes red and protruding; surface and 
extremities cold, or cold and hot alternately; wild demeanor; 
puerperal mania, w T ith great depression of spirits, pain in the 
back of the head and neck, congestion of the base of the brain, 
dilated pupils, blur before the eyes, lochia arrested or very 
scanty. 

Arsenicum. — Restless, sleepless and in constant mental agony; 
poor appetite, eats only under compulsion; pain in occiput, 
running up over the head to forehead; eyes have a blur over 
them so that she can scarcely see ; says she cannot control her 
mind; tongue bright red and seamed; hands and feet cold; 
bowels constipated; suicidal mania, attempts to strangle herself 
with a string at night, though constantly watched. 

Crocns. — Fickle, changeable disposition ; cheerfulness, mirth, 
joy, sadness, despair all follow each other in rapid succession; 
religious mania, gloomy, sad mood, with great anxiety about 
the future. 

Sepia. — Imagines things he does not want to imagine; uses 
wrong expressions, knowing them to be wrong; proposes to him- 
self things contrary to his intentions; is in contradiction with 
himself; has paroxysms of laughter and weeping in alterna- 
tion, without either of them resulting from a corresponding 
frame of mind ; gastric disturbances, with constipation. 

Cuprum. — Acute, furious mania, attended with full, quick pulse, 
red and inflamed eyes, wild looks, incoherent speech and rage, 
every paroxysm terminating in perspiration. 



248 NERVOUS THERAPEUTICS. 

Tarantula. — Restlessness of the hands and legs, constant 
movement, cannot remain in one place; great and constant 
heat about the epigastrium; disposition to joke and laugh and 
play tricks, with impulsive movements; sudden, foxlike and 
destructive efforts, requiring the utmost vigilance to prevent 
damage, followed by laughter and then apologies; all the symp- 
toms relieved by music; screams, sings, bites, throws things 
violently about, springs out of bed, destroying whatever she 
can get hold of; sleeps two days, then awakes with screaming; 
soils the bed with urine. 

Compare, also, Cimicifuga, Veratrum, Platina, Ignatia, Can- 
nabis ind., Phosphoric ac, Iodium, Pulsatilla, Zincum, Staph- 
isagria, Alumina, Nitric ac, China, Rhus tox. 

Auxiliary Treatment. — The patient should, if possible, be 
removed from his own home to a sanitarium, or place where 
the surroundings are such as to lead him to forget his malady, 
or at least to so occupy his mind by new objects as to divert it 
from the old, and not to call up, by sight or otherwise, any of 
those ideas or objects which occasioned, or are liable to renew 
or aggravate, the malad}^. Moral rather than physical restraint 
should be employed, the patient being at all times encouraged 
to exercise his own self-control. Hence his attendant should 
be a person of great discretion, self-control, kindness and 
watchfulness, the latter being exercised in such a manner as 
not to attract the patient's attention. Everything about the 
patient should be made to appear as cheerful as the circum- 
stances of the case will admit. Thus the room ordinarily 
occupied should be light, well ventilated and ornamented with 
pictures, flowers and .everything calculated to gratify the inno- 
cent tastes of the patient. Employment, recreation and vari- 
ous forms of amusement, suited to the capacity of the patient, 
should be provided for him, both as stimulants in the renewal 
of health and to prevent the mind reacting on itself. As the 
patient improves, his attention should be gradually, but cau- 
tiously, directed to former objects and associations, until all 
danger of shock or relapse has passed. The diet should always 
be generous and such as is suited to an anaemic or debilitated 
state of the system. Many a threatened attack of mania may 



DIPSOMANIA. 249 

be prevented by the timely administration of a warm bath, 
stimulants and a generous diet. 



DIPSOMANIA. 

Synonyms. — Oinomania; Fr., Manie Ebrieuse, Manie Crapu- 
leuse ; Ger., TrunJcsucht. 

Definition. — A morbid condition of the nervous system, 
characterized by an inordinate craving, generally periodic, for 
alcoholic stimulants. 

Diagnosis. — This disease is liable to be confounded with 
habitual drunkenness. In the former, however, the craving- 
exists independent of external circumstances of temptation, 
while in the latter it consists mainly in a desire to maintain a 
condition of stimulation to which the patient has become 
accustomed. 

Pathology. — This form of insanity, like that of others, can 
generally be traced in the family history. The pathological 
changes are marked in all cases, but they vary greatly, accord- 
ing to the stage of the disease. There is always more or less 
atrophy of the cortical substance, with degeneration of the 
ganglion cells. As the tendency is to dementia, very few 
organs of the body escape disease, of which fatty degeneration 
of the heart, liver, kidneys and voluntary muscles is the most 
constant. Permanent intellectual and moral degradation 
characterizes the disease, and if the patient lives long enough 
he is almost certain, sooner or later, to become hopelessly 
demented. 

Clinical Experience. — This is not very encouraging. 
Sulphuric ac, Tartar emet., Angelica, China, Arsenicum, Nux vom., 
Pulsatilla, and especially Strychnia (-£-$ gr. of the nitrate, three 
times a day for six weeks), have helped and sometimes cured 
individual cases; but unless the dipsomaniac can be secluded 
in an asylum long enough to work a change in the nutrition 
of the brain, the morbid tendency is not likely to be eradicated 
by any treatment, however judicious or prolonged it may be. 

Therapeutic Indications. — See the following section, mania 
a potu. 

17 



250 NERVOUS THERAPEUTICS. 



MANIA A POTU. 



Synonyms. — Delirium Tremens, Trembling Delirium ; Fr., 
Delire Ebrieuse, Delire Crapuleuse; Ger., Zitterwahnsinn. 

Definition. — A form of delirium, characterized by great 
mental agitation and muscular tremor, peculiar to persons ad- 
dicted to the immoderate use of alcoholic stimulants. 

Diagnosis. — It is scarcely possible to mistake the disease 
for any other, as, in addition to the history of the case, we have 
the characteristic symptoms, such as complete insomnia, 
tremor of the voluntary muscles, and, above all, the mental 
symptoms, such as imaginary fears, visions of snakes, insects, 
monsters, etc. 

There are two forms, the acute (mania a potu proper), without 
trembling, and the chronic (delirium tremens proper), with 
trembling, after which the disorder is named. 

Pathology.— The most recent observations and experiments 
conclusively prove that, contrary to the old notion, the phe- 
nomena of delirium tremens do not arise from the sudden 
withdrawal of an accustomed stimulus, but from the effects of 
its accumulation in the system, just as mercurial tremors arise 
from the inhalation of mercurial fumes. After a time, depend- 
ing on the susceptibility of the drinker, the system becomes, so 
to speak, saturated with alcohol, and after that no more can be 
taken without producing the trembling and other nervous 
symptoms peculiar to the disease. No characteristic morbid 
changes are observed after death in the acute form; in the 
chronic they resemble, when present, those of dipsomania, 
which see. 

Clinical Experience. — Belladonna, Stramonium, Hyoscyamus, 
Opium, Cimicifuga, Cannabis ind., Capsicum and Tartar emet. are 
all effective remedies, while Arsenicum, Agaricus, Nux vom., Digi- 
talis, Scutellaria and Cypripedium are also of much benefit in 
particular cases. 

Therapeutic Indications. — Belladonna. — Delirium, with 
visions of rats, mice, etc. ; imagines he sees water running over 
the table and window panes; tries to extract one of his teeth; 
smiles and stammers; dry feeling in the throat, with difficulty 



MANIA A POTU. 251 

of swallowing; fever, with thirst; cerebral congestion; restless, 
anxious and unsteady in his walk and actions; trembling of 
the hands. 

Stramonium. — Delirium, with frightful visions and hallucina- 
tions; sees animals and strangers attacking him from all sides; 
hides himself, or tries to escape; hears imaginary voices; face 
red and swollen; eyes glistening and staring; manner hurried 
and fitful ; limbs in a constant tremor ; talks absurdly, laughs, 
starts at every sound and movement and looks greatly fright- 
ened; complete insomnia. 

Hyoscyamus. — Starts and trembles as if by* fright; wants to 
hide from the light and from company; fears persecution; con- 
stantly tossing about at night, cannot sleep; derangement of 
the stomach, with loss of appetite; disposed to laugh at his 
own fears, yet trembles in every limb. 

Opium. — Stupor, from which the patient starts in great fright 
or mutters in his sleep, talking deliriously; dreams of animals 
glaring at him with their fiery-red eyes ; trembles, looks fright- 
ened and tries to escape ; becomes comatose, with loud, snoring 
respiration, dilated pupils and half-closed eyes; reduced vital 
power. 

Cimicifuga. — Complete insomnia; imagines he sees rats, mice, 
lizards and other strange objects; talks incessantly, changing 
from one subject to another without any good reason; pulse 
full and quick; eyes wild and staring; stomach disordered; 
cross and taciturn ; tremor scarcely visible, but apparent to 
the touch ; occipital headache. 

Cannabis ind. — Illusions of a spectral character and of strange 
sounds at night; wakes before midnight overcome with fright; 
imagines he is going to be choked; all objects appear double 
their natural size; talks incoherently, stammering and stut- 
tering; everything, even his own hand, appears monstrously 
large. 

Capsicum. — Prostration extreme, tremor excessive, delirium 
bland; thinks the ceiling is about to fall and crush him, caus- 
ing him to jump from the bed as quickly as his weak condition 
would allow; tongue coated, pulse small and irregular, skin 
moist, forehead constantly bedewed with a cold, clammy sweat; 



252 NERVOUS THERAPEUTICS. 

voice feeble, husky and tremulous; complete insomnia for 
three successive nights. 

Antimonium tart. — Fearful delirium; constantly throwing 
pillows at imaginary demons; eyes red and injected; pulse 
quick and irritable; has neither eaten nor slept for more than 
a week; gastric derangement from drinking beer; low states of 
the system, with profuse, cool sweats. 

Arsenicum. — Muscular tremors, with great prostration; fear, 
with great anguish and sweat, dread of ghosts, of thieves or of 
death, and especially of vermin crawling over the bed or over 
the hands; gastritis. 

Grelsemium. — Delirium, with great nervous excitement, head- 
ache, fear and wakefulness; had not slept for ten nights; 
kicked off the footboard struggling with his attendant, con- 
stantly calling for more whisky; produced sleep after morphia 
had failed. 

Compare, also, Nux vom., Gratiola, Coffea, Kali brom., Ran- 
unculus bulb., Nux mosch, Digitalis, Calcarea. 

Auxiliary Treatment. — Confinement always irritates the 
patient and increases his fears; no more restraint, therefore, 
should be placed upon his movements than is necessary to pre- 
vent accidents. The chief danger to be guarded against is ex- 
haustion ; hence care should be taken to provide for the nutri- 
tion of the impoverished brain and nerve-centres, by the free 
administration of food which can be easily digested and 
assimilated. Beef-tea, raw eggs and milk or warm coffee, coca, 
warm milk and egg-emulsion will usually give satisfactory 
results. Aitken recommends Cayenne pepper. The stimulus 
of such a spice, he says, given in soup, on the atonic stomach, 
will have a favorable influence on absorption. Lilienthal ad- 
vises us to keep our patients on an exclusive milk diet, as it 
antidotes alcohol and sometimes causes a disgust for it. 

DEMENTIA. 

Synonyms. — Mental Decay; Fr., Demence; Ger., Blbdsinn. 
Definition. — A gradual decay of the mental faculties. 
Diagnosis. — Acute primary dementia, which does not come 



DEMENTIA. 253 

under the above definition, sets in rapidly without any preced-' 
ing disorder, affects only young people, usually girls, and is 
amenable to treatment. Chronic primary dementia, though 
sometimes a sequel of the acute, usually comes on gradually, 
and when not caused by disease of the brain generally results 
from years of hard drinking, its chief symptom being loss of 
memory. Secondary dementia, which is the form to which the 
term is usually applied, is a sequel to previous mental disorder, 
such as melancholia and mania. These distinctions are suffi- 
cient for diagnostic purposes. 

Pathology. — The pathological condition, in most cases of 
dementia, is one of diffuse interstitial inflammation of the great 
nervous centres, which results eventually in destruction of 
ganglion cells and atrophy of the nervous structures. Indeed, 
the degree of imbecility is generally pretty accurately measured 
by the amount of atrophy and destruction of ganglion cells 
which the cerebral nerve-centres have undergone. 

Treatment. — On this point little can be said. The same 
careful tending and nursing are required as in infancy, the 
weakness and helplessness being equally great. Although, 
with the exception of the acute primary form, a cure is not 
to be expected, medicines are often of great utility. Such 
remedies as Arsenicum, Acidum nit. and phosph., Carbo veg., 
China, Digitalis, Phosphorus, JSux vom., Pydophyllin, etc., are 
frequently required to render the patient more comfortable 
and to prolong his life; while during the earlier stages the 
decay of the mental faculties may be greatly retarded, and in 
some cases arrested, by Anacardium, Ignatia, Phosphoric ac, etc., 
the selection being determined, as in all other cases, in accord- 
ance with the symptoms presented by the patient at the time 
of prescribing.* 

* From the author's work on Nervous Diseases, p. 379. 



INDEX. 



Section I. — Diseases. 



Abnormal growths, cerebral, 48 

spinal, 111 

Abscess, cerebral, '^2, 35 
Acute ascending paralysis, 9-1 

— hydrocephalus, 67 
Adults, spiual paralysis of, 95 
Alalia, 37 

Alkaline solvents, 29 
Amyotrophic lateral sclerosis, 102 

— paralysis, 101 
Anemia, cerebral, 9 

— antero-lateral columns, 78 

— cerebro-spinal, 117 

— general, 117 

— posterior columns, SI 

— posterior spinal, SI 

— spinal. 7^ 

Anapeiretic paralysis, 188 
Anesthesia, 27, 192 

— peripheral, 192 

Antero-lateral columns, anemia of, 78 
Anterior horns, inflam. of, 95 
Angina pectoris, 200 
Antero-spinal paralysis of infancy, 97 
Aphasia, 37 

Aphemia, 37 
Aphonia, paralytic, 181 
Apoplectic stroke, 21 
Apoplexy, cerebral, 21 

— spinal, 84 
Apoplexia sanguinia, 21 
Arachnitis, cerebral, 60 

— spinal, 85 

— traumatic, 60 

Artificial delivery in puerperal convulsions, 137 
Ascending and descending degenerations, 162 
Asthenic paralysis, 1S5 
Ataxia, locomotor, 107 
Atrophia cerebri, 40 

— musculorum lipomatosa, 98 
Atrophic spinal paralysis, 95 
Atrophv, cerebral, 42 

— facial, 194 

— Cruveilhier's, 101 

— progressive muscular, 101 

facial, 191 
Athetosis, 44, 56 



Bandages in sciatica, 180 
Basedow's disease, 198 
Baths, salt, 26, 185 

— sea, 168, 170 

— shower, 208 

— steam. 152 

— sun, 209 

— vapor, 200 

— warm, 111, 147, 190, 240 
Bowels, neuralgia of, 211 
Brain, anemia of, 9 

— arachnoid, inflam. of, 60 

— atrophy of, 40 

— concussion of, 50 

— congestion of, 14 

— dropsy of, 73 



Brain, hemorrhage of, 21 

— hyperemia of, 14 

— hypertrophy of, 39 

— pia mater, inflam. of, 60, 62 

— softening of, 34 

— suppurative inflam. of, 32 

— syphilitic disease of, 45 

— tumors of, 48 

— water on, 73 
Brain-fag, 9, 117 
Breast-pang, 200 
Bronchocele, exophthalmic, 198 
Brown-Sequard on cerebral syphilis, 46 

" vitalizing fluid," 122 

Bumpf s treat, of locomotor ataxia, 111 
Bulbar paralysis, 99 



Canine madness, 148 
Cardiac neuralgia, 200 
Cardialgia, 204 
Cams, 229 

— catalepsia, 161 
Catalepsy, 161 

Cauterization, prophylactic, 151 
Central myelitis, 144 
Cephalalgia, 195, 214 

— periodica, 195 
Cerebral anemia, 9 

— abscess, 32 

— apoplexy, 21 

— arachnitis, 60 

— atrophy, 40 

— concussion, 50 

— congestion, 14 

— embolism, 30 

— hemorrhage, 21 

— hyperemia, 14 

— hypemia, 9 

— hypertrophy, 39 

— leptomeningitis, traumatic, 61 

— meningeal hemorrhage, 59 

— meningitis, chronic, 71 
granular, 67 

simple acute, 62 

tubercular, 67 

— pachymeningitis, acute, 58 
chronic, 59 

external, 58 

internal, 59 

secondary, 58 

traumatic, 58 

— paralysis, 54 
infantile, 56 

— sclerosis, diffused, 40 
multiple, 42 

— softening, 34 

— syphiloma, 71 

— syphilis, 45, 71 

— thrombosis, 27 

— tumors, 48 
Cerebro-spinal hyperemia, 116 

anemia, 117 
meningitis, 123 
fever, 123 



(255; 



256 



INDEX. 



Cerebro-spinal sclerosis, 162 
Cerebrasthenia, 10, 117 
Cerebritis, 32 
Coccvgodvnia, 175 

Cold* applications, 20, 54, 57, 84, 85, 175, 
190 

— douche, 54, 175 

Childhood, essential paralysis of, 97 
Chorea, 152 

— minor, 152 

— Sancti Yiti, 152 

Chronic cerebral meningitis, 71 

— inflam. of brain, 32 

— hydrocephalus, 73 

Columns of Burdach, sclerosis of, 107 
Coma somnolentum, '229 
Compression, in neuralgia, 168, 170 

— in chronic hydrocephalus, 75 

— in hystero-epilepsy, 160 
Commotio medulla spinalis, 112 

— cerebralis, 50 
Congestion, cerebral, 14 

— cerebro-spinal, 116 

— spinal, 76 
Concussion, cerebral, 50 

— spinal, 112 
Convulsions, cholaemic, 138 

— infantile, 129 

— of pregnancy and parturition, 134 

— of the new-born, 134 

— postnatal, 133 

— puerperal, 134 

— toxaeniic, 138 

— uraeniic, 134, 138 
Convulsive tic, 187 
Cretinism, mucoid, 199 
Croup, spasmodic, 189 
Cruveilhier's atrophy, 101 
Cutaneous anaesthesia, 192 



Debility, nervous, 117 
Degeneration, cerebral, diffused, 40 
multiple, 42 

— spinal, primary, 104 
secondary, 206 

— cerebro-spinal, 160 
Delirium tremens. 250 
Dementia, 163, 252 

— paralytica, 163 
Diet in athetosis, 45 

— anaemia, 13 

— bulbar paralysis, 101 

— meningitis, cerebral, 60 
cerebro-spinal, 129 

— convulsions, toxic, 139 

— cerebral thrombosis, 29 

— delirium tremens, 252 

— epilepsy, 144, 157 

— encephalitis, 34 

— ext. pachymeningitis, 59 

— haemorrhage, cerebral, 26 

— hemicrania, 198 

— insomnia, 236 

— mania, 248 

— melancholia, 240 

— neuralgia, 168, 170, 181 

— neurasthenia, 122 

— sciatica, 1S1 

— spinal anaemia, 80 

meningitis, chronic, 88 

— tubercular meningitis, 71 

— tetanus, 146 

— the Weir Mitchell, 122 
Differential diagnosis, in 

— anaemia, cerebral, 9 
general, 117, 118 

— angina pectoris, 201 

— cerebral compression, 50 



Differential cerebral concussion, 50 

embolism, 27 

epilepsie, 157 

hyperaemia\ 9 

180, paralysis, infantile, 59 

thrombosis. 27 

paralysis, cerebral, 56 

spinal, 56 

infantile, 97 

— hysteria, 118, 157 

— progressive muscular atrophy, 97 

— neurasthenia, 117, 118 

— peripheral neuritis, 96 

— poliomyelitis. 96 

— simple meningitis, basilar, 63 
tubercular, 67 

— typhoid fever, 67 
Diffused cerebral sclerosis, 40 
Diplegia facialis 184 
Diphtheritic paralysis, 185 
Dipsomania, 249 
Disseminated sclerosis, cerebro-spinal, 162 

cerebral, 42 

multilocular, 103 

spinal, 103 

Dizziness, 223 
Dog-madness, 148 
Douche, cold, 54, 98, 115 

— salt-water, 115 

— spray, 90 

Dowse, Dr. , on cerebral syphilis, 46 
Dropsy of the brain, 73 
Duche'nne's disease, 99 



Eclampsia gravidarum et parturientium, 134 

— infantum. 129 

— neonatorum, 1:34 

— toxica, 138 

Electricity in angina pectoris, 204 

— athetosis, 45 

— bulbar paralysis, 100 

— catalepsy, 161 

— cerebral' anaemia, 13 
atrophy, 41 

■ htemorrhage, 44 

hyperaemia, 20 

sclerosis, 44 

tumors, 49 

— chorea, 156 

— coccygodynia, 177 

— diphtheritic paralysis, 185 

— facial paralysis. 184 

— glossoplegia, 187 

— hydrophobia, 152 

— hysteralgia, 210 

— locomotor ataxia, 111 

— muscular atrophv, 96 

— neuralgia, 168, 170, 173 

— neurasthenia, 121 

— peripheral anaesthesia, 194 

— paralytic aphonia, 181 

— sciatica, 180 

— spinal hyperaemia, 78 

— — irritation, 84 

meningitis, S8 

paralysis of adults. 97 

infantile, 97 

pseudo-hypertrophic, 99 

sclerosis, 104 

Electric brush, 111, 194 
Electro-cautery, 88 
Electro-massage, 97 
Embolic dust, 31 
Embolism, solvents in, 29 
Emotional insanity, a41 
Encephalitis, 32 
Enemata, 168 
Entasia tetanus, 144 



INDEX. 



257 



Enterodynia, 211 

Enteralgia, 211 

Epidemic meningitis, 123 

Epilepsia, epilepsis, 139 

Epileptiform hysteria, 159 

Epilepsy, 139 

Essential paralysis of Childhood, 97 

Ether-spray.lSO, 204 

Exhaustion, nervous, 117 

— spinal, 78 

Exophthalmic goitre, 198 

Exercise, 20, 27, 115, 185, 190,240 

Externa] cerebral pachymeningitis, 58 

Extirpation of the coccyx, 177" 



Facial atrophy, 191 

— neuralgia, 171 

— paralysis, 1S4 

— spasm. 187 
Falling-sickness, 139 
Femero-popliteal neuralgia, 177 
Functional paralysis of the cord, 78 
Furor mania, 243 



Galvanism in 

— athetosis, 45 

— cerebral atrophy, 41 

■■ haemorrhage, 26 

hyperemia, 20 

sclerosis, 44 

tumors, 49 

— exophthalmic goitre, 199 

— facial paralysis, 184 

— gastralgia, 208 

— hydrophobia, 150 

— locomotor ataxia, 111 

— infantile spinal paralysis, 98 

— neuralgia, 173, 180 

— paralytic aphonia, 184 

— progressive muscular atrophy, 102 

— sciatica, 180 

— sclerosis, 104 

— spinal concussion, 115 
irritation, 84 

meningitis, chronic, 88 

— vertigo, 229 

— writer's cramp, 188 

— wry-neck, 188 
Gastralgia, 204 
Gastrodynia, 204 
General paralysis, 163 

paresis, 163 
Glossoplegia, 186 

Glosso-labio-laryngeal paralysis, 99 
Glottis, spasm o"f, 189 
Giddiness, 223 
Goitre, exophthalmic, 198 
Granular cerebral meningitis, 67 
Grave's disease, 198 
Gumma syphiliticum cerebri, 45 
Gussenbauer on trifacial neuralgia, 171 
Gymnastic exercise, 15, 188 



Hematoma dura matris, 59 
Hjematomyelia, 84 
Haematorrhagia medulla spinalis, 84 
Hemorrhagic pachymeningitis, 59 
Haemorrhage, cerebral, 21 

— meningeal , 59 

— spinal, 84 
Heartburn, 204 
Heat-stroke, 52 
Hammond's athetosis, 44 
Headache, 195, 214 
Hemicrania, 195 



Heat, artificial, in 

cerebral hypersemia, 2) 

paralysis, 57 

meningitis, 67 

softening, 36 

— cerebro-spinal meningitis, 129 

— enteralgia, 213 

— hysteralgia, 210 

— mastodynia, 175 

— neuralgia, 168, 170 

— neuritis, 166 

— ovaralgia, 208 

— spinal hypersemia, 78 
irritation, 84 

— tetanus, 145 
Hemiplegia, 54 

— cerebralis spastica, 56 
Hot douche. 78 
Hydrocephalus, acute, 67 

— acutus sine tuberculosis, 62 

— chronic, 73 

— internal, 67 
Hydrops capitis, 73 
Hydrophobia, 148 
Hyperesthesia plexus cardica, 200 
Hvpertrophia cerebri, 39 

Hypo, 240 

Hypochondriasis, 240 
Hypoglossal nerve, paralysis of, 1S6 
Hyperemia, cerebral, 14 " 

— cerebro-spinal, 116 

— spinal, 76 
Hysteria, 118,. 156 

— cataleptica, 161 

— epileptica, 157 
Hysteric fit, 156 
Hysterics, 156 
Hystero-epilepsy, 159 
Hysteralgia, 210 

Hyperplasia, cerebral neuroglia, 39 
Hypertrophy, cerebral, 39 

Ice and ice-water applications, 54, 57, 66 

115, 129, 147, 152, 160, 166. 
Idiopathic cerebral leptomeningitis, 62 

— latent spinal sclerosis, 104 

— softening of the cord, 90 
Impulsive insanity, 241 
Infantile cerebral paralysis, 56 

— convulsions, 129 

— spinal paralysis, 97 
Inflammation of the anterior horns, 95 

— lateral columns, 102 

— nerve, 166 

— spinal cord, 88 

Inflammatory softening of the cord, 88 
Inhibitory paralysis, 78 
Inanition, convulsions from, 138 
Insane, paralysis of, 163 
Insanity, affective, 241 

— common, 243 

— emotional, 241 

— impulsive, 241 

— intellectual, 243 

— moral, 241 
Insolation, 52 
Insomnia, 232 
Insolatio, 52 

Internal cerebral pachymeningitis, 59 
Insular spinal sclerosis, 103 
Irritable uterus, 210 
Irritation, spinal, 84 
Ischias, 177 



Karl Pauli on locomotor ataxia, 111 
Labio-glosso-laryngeal paralysis, 99 



258 



INDEX. 



Landry's paralysis, 94 

Lateral columns, inflam. of, 102 

— sclerosis, idiopathic, 104 

amyotrophic, 102 

primary, 104 

Laryngismus stridulus, 189 
Larynx, paralysis of, 181 

— spasm of, 189 
Leptomeningitis, cerebral, 61, 62 

— infantile, 62 

— idiopathic, 62 

— spinal, 85 

— traumatic, 61 

— tubercular, 67 
Lethargia, 229 
Lethargy, 229 

Lipomatosis musculorum luxurians, 98 
Local anaesthesia, 192 
Lockjaw, 144 
Locomotor ataxia, 107 
Lyssa, 14S 



Madness, 148, 243 
Malum hysterieum, 156 
Mamma?,"neuralgia of, 174 
Massage, 13, 26, 97, 120, 139, 1S4, 194, 

— electro, 97 
Melancholia, 237 
Mania, 243 

— a potu, 250 
Mastalgia, 174 
Mastodynia, 174 
Megrim, 196 

Meningeal haemorrhage, cerebral, 59 

— tumors, spinal, 112 
Meninges, spinal, inflam. of, 85 

— certbral, inflam. of, 60, 62 
Meningitis, basilar, 62, 71 

— cerebral, 60, 62, 71 

— cerebro-spinal, 121 

— chronic, 71 

— convexital, 71 

— epidemic, 121 
spinal, 85 



240 



— simple acute, 62 

— subarachnoid, 60 



— syphilitic, 71 

— tubercular, 62, 67 
Mental decay, 252 

Metallothera'py in hystero-epilepsy, 160 
Mimetic spasm, 1S7 

M*)ral insanity, 241 

— treatment, *159, 240, 248 
Morbus attonitus, 161 

— hypochondriacus, 240 

— magnus, major, dsernonius, divinus, deificus, 

luuaticus, etc., 139 
Mollities medulla; spinalis, 90 
Mucoid cretinism, 199 
Muscular atrophy, 96, 101 
progressive, 96 

— paralysis, progressive, 101 

— pseudo-hypertrophie, 98 
Multilocular sclerosis, disseminated, 103 
Multiple sclerosis, cerebro-spinal, 162 
cerebral, 42 

spinal, 103 

Myelitis, acute, 88 

— bulbi, 99 

— central, 144 
Myelasthenia, 78, 117 
Myelomalasia, 90 
Myopathic paralysis, 101 
Myxcedema, 199 



Nerves, inflam. of, 166 

Nerve-stretching, 73, 110, 146, 166, 168, 170, 173 



Nervous exhaustion, 117 

— headache, 195 

— pain, 167 
Neuralgia, in general, 167 

— of the bowels, 211 

— cardiac, 200 

— of the coccyx, 175 

— feniero-popliteal, 177 

— intercostal, 177 

— ischiatic, 177 

— of the mammse, 174 

— meseraic, 211 

— ovarian, 208 

— phrenic, 200 

— spinal, 81 

— of the stomach, 204 

— trifacial, 171 

— uterine, 210 
Neural anaesthesia, 192 
Neuritis, 166 
Neurodynia, 167 . 
Neuroglia, hyperplasia of, 39 
Neurasthenia, 9, 78, 117 

— cerebralis, 9 

— spinalis, 78, 117 
Neurotic facial atrophy, 191 
Nutrition, 168, 170 

Oinomania, 249 
Ovaralgia, 208 
Ovarian irritation, 208 

— neuralgia, 208 
Ovaries, pain in, 208 

Ord's cretinoid affection, 199 



Pain, neuralgic, 167 

— ovarian, 208 
Paralytic aphonia, 1S1 
Paralysis, cerebral, 54 

— acute ascending, 94 
progressive, 94 

— antero-spinal, of infancy, 97 

— anapeiretic, 188 

— agitans, 164 

— atrophica, 101 

— ascendens acuta, 94 

— amyotrophic, 101 

— asthenic, 185 

— Bell's, 184 

— Cruveilhier's, 101 

— diphtheritic, 185 

— facial, 184 

— functional 78 

— general, oi the insane, 163 

— glosso-labio-laryngeal, 99 

— histrionic, 183 

— infantile, 97 

— inhibitory, 78 

— Landry's, 94 

— mvopathic, 101 

— of adults, 95 

— of the hypoglossal nerve, 186 

— of the larynx, 99, 181 

— of the pharynx, 99, 181 

— of the portio dura 183 

— of the tongue, 186 

— progressive bulbar, 99 

— pseudo-hvpertrophic, 98 

— reflex, 93* 

— spasmodic, 104 

— spinalis spastica, 104 

— spinal, 92-107 
of adults, 95 

— toxic, 93 

Palsy, common cerebral, 54 

— shaking, 164 

— Schrivener's, 188 

— spinal, 78, 92 



INDEX. 



259 



Paralytic aphonia, 181 
Paraplegia, 92 

— reflex, 78 
PanplexuL 92 

Parrs treat., writer's cramp, 1S8 
Pasteur on hydrophobia, 149 
Pachymeningitis, acute cerebral, 58 

— chronic, 59 

— external, 58 

— hemorrhagic, 59 

— internal, 59 

— secondary, 5S 

— spinal, 85 

— traumatic, 58 
Peripheral anaesthesia, 192 

— neuritis, 96 
Pervigilium, 232 
Pharynx, paralysis of, 99, 1S1 
Pia mater, cerebral, inflam. of, 62 
Phrenic nerve, neuralgia of, 200 
Poliencephalitis acuta^SG 
Poliomyelitis anterior, 95 
Polymyositis, progressive, 101 
Posterior spinal anemia, 81 

sclerosis, 107 

Post-diphtheritic paralysis, 185 
Postnatal convulsions, 133 
Primary sclerosis, lateral, 104 
cerebral, 42 

spinal, 104 

— softening, spinal, 90 
Progressive bulbar paralysis, 99 

— facial atrophy, 191 
■ hemiatrophy, 191 

— locomotor ataxia, 107 

— muscular atrophy, 101 

— polymyositis, 101 
Prophylaxis in hydrophobia, 151 
Prosopalgia, 171 

Pseudo-hypertrophie spinal paralysis, 98 
Puerperal convulsions, 134 

Pyiemia, in cerebral pachymeningitis, 58 

Rabies, 148 

Rachialgia, 81 

Reflex paraplegia, 78, 93 

— paralysis spinalis, 78 

Rest, in "cerebral thrombosis, 29 

— hemicrania, 198 

— melancholia, 240 

— neurasthenia, 122 

— spinal hemorrhage, 85 

irritation, 84 

concussion, 115 

— writer's cramp ; 188 
Restraint in delirium tremens, 252 

— mania, 250 

Salt-bath, in cerebral anemia, 13 

— hemorrhage, 28 
St. Guy's dance, 152 

— John's dance, 150 

— Vitus's dance, 150 
Sciatica, 177 
Schrivener's palsy, 188 
Sclerosis, cerebral, 41, 42 

— diffused, 41 

— disseminated, 42 

— idiopathic, 42 

— insular, 42 

— multiple, 42 
primary, 42 

— columns of Burdach, 107 

— spinal, 103, 104, 106 

amyotrophic lateral, 102 

primary, 104 

disseminated, 103 

multiple, 103 



Sclerosis, spinal, secondary, 106 

— cerebrospinal, 162, 165 

disseminated, 162 

secondary, 162 

Sea-bathing in neuralgia, 168, 170 

— cerebral amentia, 13 
Secondary spinal sclerosis, 106 

— cerebro-spinal sclerosis, 162 
Shaking palsy, 164 
Shower-bath," in gastralgia, 208 
Sick-headache, 195 

Simple acute cerebral meningitis, 62 
Sleeplessness, 232 
Softening, cerebral, 34 

— spinal, 90 
Somnolentia, 229 
Somnolency, 229 
Sopor, 229 
Spasmodic croup, 189 

— spinal paralysis, 104 
Spasm, facial, 187 

— laryngeal, 189 

— mimetic, 187 

— of the glottis, 189 
mastoid muscle, 187 

— with rigidity, 144 
Speech, loss of, "37 
Spotted fever, 123 
Spinal anemia, 78, 81 

— apoplexy, 84 

— arachnitis, 85 

— concussion, 112 

— congestion, 76 

— exhaustion, 78 

— hemorrhage, 84 

— hyperemia, 76 

— inflammation, 88 

— irritation, 81 

— leptomeningitis, 85 • 

— meningitis, 85 

— neuralgia, 81 

— pachymeningitis, 85 

— paralysis, 78, 92 

of" adults, 95 

atrophic, 95 

functional, 78 

infantile, 97 

simple, 92 

spasmodic, 104 

pseudo-hypertrophie, 98 

— sclerosis, disseminated, 103 

— — multiple, 103 

primary, 104 

posterior, 107 

secondary, 106 

— tumors, 112 

Spinal cord, anemia of, 78, 81 

— concussion of, 112 

— hyperemia of, 76 

— inflam. of, 88 

— inflammatory softening of, 88 

— non-inflammatory softening of, 90. 

— paralysis of, 78 

— sclerosis of, 103, 104, 160 
Spleen, 240 

Spotted fever, 123 

Steam-bath, in hydrophobia, 151 

Sternalgia, 200 

Sternodynia, 200 

Sternocardia, 200 

Stomach, neuralgia of, 204 

Stupor, 229 

Subarachnoid meningitis, 61 

Sun-bath, in ovaralgia, 209 

Sunstroke, 52 

Suspension, in locomotor ataxia, 111 

Syphilis, cerebral, 45 

Syphiloma, 45 

Syncope anginosa, 200 



260 



INDEX. 



Swimming of the head, 223 
Syphiiitic meningitis, chronic, 71 



Tahes dorsalis, 107- 

Tapping, in chronic hydrocephalus, 75 

Tetanus, 144 

Thermic fever, 52 

Thrombosis, cerebral, 27 

— solvents in, 29 
Tongue, paralysis of, 186 
Torticollis, 187* 
Toxemic convulsions, 138 
Traumatic cerebral arachnitis, 60 
leptomeningitis, 61 

pachymeningitis, 58 

Trembling delirium, 250 
Tremors, spinal, 111 
Trigeminal neuralgia, 171 
Trismus, 144 

— nascentium, 134 

Tubercular cerebral leptomeningitis, 67 

meningitis, 67 

Tumors, cerebral, 48 

— spinal, 112 



Unilateral facial atrophy, 191 
Ursemic convulsions, 133, 136 
Uterine colic, 210 
— neuralgia, 210 

Vapor baths, in myxcedema, 200 
Vapors, 156 
Vertigo, 223 



Wakefulness, 232 

Warm baths, in insomnia, 236 

— mania, 250 

— melancholia, 240 

— spasm of glottis, 190 

— tetanus, 145 
Wasting palsy, 101 
Water on the brain, 73 

Weir Mitchell treat, in neurasthenia, 122 

— spinal irritation, 84 
White softening, spinal, 90 
Womb, neuralgia of, 210 
Writer's cramp, 188 
Wry-neck, 187 



Section II. — Remedies. 



Abrotanum in treatment of cerebral soften- 
ing, 36 
Acidum fluor. in coccygodynia, 176 
Aconite in treat, of acute myelitis, 89 

angina pectoris, 203 

cerebral hemorrhage, 23 

— hyperemia, 16 

meningitis, 64 

cerebro-spinal meningitis, 125 

facial paralysis, 184 

headache, 2*16 

infantile convulsions, 130 

insomnia, 234 

mania, 247 

mastodynia, 175 

neuralgia, 168, 172 

spinal hyperemia, 77 

meningitis, 86 

sunstroke, 53 

vertigo, 229 

iEculus hip., in treat, of locomotor ataxia, 110 
j^thusa in treat, of cerebral meningitis, 66 

cerebro-spinal meningitis, 128 

chronic hydrocephalus, 74 

Agaricus in treat, of angina pectoris, 304 

cerebro-spinal meningitis, 128 

chorea, 153' 

spinal hyperemia, 77 

Agnus cast, in treat, of melancholia, 239 
Alumina in treat, of enteralgia, 212 

headache, 220 

locomotor ataxia, 108 

spinal anemia, 80 

Allium cepain treat, of headache, 219 

Aluminum in ascending paralysis, 94 

Ambra gris. in melancholia, 239 

Ammon. pier, in neuralgia, 168 

— brom. in ovaralgia, 209 

Amyl nit. in treat, of angina pectoris, 202 

cerebral hyperemia, 16 

hemicrania, 197 

melancholia, 239 

sunstroke, 53 

vertigo, 229 

Anacardium in treat, of cerebral meningitis, 66 

headache, 216 

mania, 246 

Angustura in treat, of acute myelitis, 90 



Angustura in treat, of locomotor ataxia, 110 

myelitis, 89 

tetanus, 147 

Antimonium crud. in treat, of headache, 222 

sunstroke, 50 

Antimo. tart, in treat, of delirium tremens, 252 

diphtheritic paralysis, 184 

Apis mel. in cerebral hyperemia, 17 

— cerebro-spinal meningitis, 125 
hydrocephalus, 74 

meningitis, 65, 69 

— ovaralgia, 209 

Apocynum can. in treat, of chronic ' hydro- 
cephalus, 73 
Apomorphia in vertigo, 226 
Aranea diad. in neuralgia, 170 
Artemesia vulg. in tubercular meningitis, 69 
Argentum nit. in treat of 

cerebro-spinal meningitis, 127 

epilepsy, 142 

gastralgia, 206 

headache, 222 

locomotor ataxia, 109 

multiple cerebral sclerosis, 43 

pseudo-hypertrophic paralysis, 100 

neuralgia, 173 

spinal hyperemia, 77 

vertigo, 227 

Arnica in treat, of acute myelitis, 90 

aphasia, 38 

cerebral hemorrhage, 24 

hyperemia, 17 

paralysis, 57 

— concussion, cerebral, 51 

— facial paralysis, 184 

— myelitis, 90 

— spinal concussion, 114 
hyperemia, 78 

— sunstroke, 53 

— tetanus, 147 

Arsenicum in treat, of angina pectoris, 203 

acute myelitis, 89 

cerebral anemia, 10 

softening, 37 

cerebro-spinal meningitis, 128 

chronic hydrocephalus, 74 

delirium tremens, 252 

encephalitis, 34 



INDEX. 



2G1 



Arsenicum In treat, of enteralgia, 212 

gastralgia, 206 

headache, 196, 217, 222 

hemicrania, L96 

hysteralgia, 210 

insomnia, 236 

mania. -'47 

mastodynia, 175 

melancholia, 238 

myelitis, 89 

neuralgia. 168, 171 

neurasthenia, 119 

puerperal convulsions, 136 

sciatica 179 

spinal anaemia, 80 

vertigo, 226 

Asafcetida in treat, of headache, 219 

Asclepias syr. in treat, of cerebral hyperaeinia, 19 

puerperal convulsions, 136 

Asterias rub. in treat, of chorea, 155 
Aurum in treat, of angina pectoris, 204 

cerebral hyperemia, 18 

syphilis, 47 

locomotor ataxia, 10S 

mania, 246 

melancholia, 238 

Avena sat. in treat, of neurasthenia, 120 
cerebral anaemia, 11 



Baptisia in treat, of cerebro-spinal meningitis, 

125 
Baryta carb. in treat, of aphasia, 38 

cerebral haemorrhage, 23 

tumors, 49 

locomotor ataxia, 110 

multiple cerebral sclerosis, 43 

Belladonna in treat, of acute myelitis, 89 

cerebral concussion, 51 

haemorrhage, 23 

— hyperemia, 16 

meningitis, 64 

■ softening, 36 

tumors, 49 

cerebro-spinal meningitis, 127 

coma, 231 

delirium tremens, 250 

epilepsy, 142 

enteralgia, 213 

facial paralysis, 184 

gastralgia, 207 

headache, 215 

hemicrania, 196 

hysteralgia, 210 

infantile cerebral paralysis, 57 

convulsions, 130 

insomnia, 233 

locomotor ataxia, 109 

— — mania, 245 

melancholia, 138 

myelitis, 89 

neuralgia, 173 

puerperal convulsions, 137 

sciatica. 179 

spasm of glottis, 190 

spinal hyperaeniia, 77 

irritation, 83 

meningitis, 86 

sunstroke, 55 

tetanus, 145 

tubercular meningitis, 70 

vertigo, 226 

Berberis in treat, of cerebral syphilis, 47 

headache, 215 

spinal hyperemia, 77 

Eismuthum in treat, of gastralgia, 208 

— — headache, 219 

— — neuralgia, 169 

Bovista in treat, of headache, 217 



Bromides in treat, of cerebral hypcra?mia, 21 
Bromine in treat, of hemicrania", 197 

exophthalmic goitre, 199 
Bryonia in treat, of cerebral hyperaeinia, 16 

coma, 231 

gastralgia, 206 

headache, 220 

hemicrania, 197 

mastodynia, 175 

meningitis, cerebral, 65, 69 

spinal, 86 

tubercular, 69 

neuralgia, 169, 172 

puerperal convulsions, 136 

sciatica, 178 

vertigo, 226 



Cactus grand, in treat, of angina pectoris, 203 

Calcarea carb. in cerebral tumors, 49 

chorea, 153 

hemicrania, 196 

hydrocephalus, 74 

hysteralgia, 210 

— — tubercular meningitis, 69 
vertigo, 229 * 

Calcarea phos. in cerebral anaemia, 12 

chronic hydrocephalus, 75 

headache, 222 

neurasthenia, 80, 119 

spinal anaemia, 80 

tubercular meningitis, 69 

Calcis hypophos. in treat, of neurasthenia, 121 

Camphor in treat, of cerebral anaemia, 11 

coma, 231 

concussion, 51 

sunstroke, 53 

Camphor brom. in treat, of infantile convul- 
sions, 130 

Calendula in treat, of spinal concussion, 114 

Cannabis ind. in treat, of cerebro-spinal men- 
ingitis, 126 

delirium tremens, 251 

epilepsy, 141 

Cantharis in treat, of cerebro-spinal menin- 
gitis, 128 

Capparis cor. in treat, of epilepsy, 141 

Capsicum in treat, of delirium tremens, 251 

Carbo veg. in treat, of gastralgia, 206 

sunstroke, 53 

Carbo an. in treat, of headache, 222 

coccygodynia, 177 

Caulophyllum in treat, of headache, 217 

hysteralgia, 210 

Causticum in treat, of acute myelitis, 89 

aphasia, 38 

chorea, 153 

diphtheritic paralysis, 185 

facial paralysis, 184 

headache, 216 

myelitis, 90 

ocular paralysis, 72 

vertigo, 22S 

Cedron in treat, of headache, 220 

Chamomilla in treat, of aphasia, 40 

— — coma, 231 

enteralgia, 212 

headache, 215 

infantile convulsions, 132 

mastodynia, 175 

sciatica", 179 

Chelidonium in treat, of headache, 219 

China in treat, of cerebral anaemia, 10 

gastralgia, 207 

spinal anaemia, 80 

vertigo, 226 

China ars. in treat, of epilepsy, 143 

China sulph. in treat, of neurasthenia, 119 

vertigo, 226 



262 



INDEX. 



Chlorine in treat, of spasm of glottis, 190 
Cicuta in treat, of cerebral concussion, 51 

cerebro-spinal meningitis, 125 

coecygodvnia, 176 

chorea, 154 

infantile convulsions, 132 

spinal concussion, 114 

meningitis, 87 

tetanus, 145 

vertigo, 228 

Cimicifuga in treat, of cerebral hyperemia, 18 

meningitis, 66 

cerebro-spinal meningitis, 124 

chorea, 153 

deliriurn tremens, 251 

hysteralgia, 210 

insomnia, 234 

mastodynia, 175 

melancholia, 239 

ovaralgia, 209 

spinal irritation, 82 

Cina in treat, of cerebral anaemia, 12 

chorea, 155 

infantile convulsions, 131 

tubercular meningitis, 70 

Cinnabaris in treat of cerebral syphilis, 47 

Coca in treat, of insomnia, 235 

Cocculus in treat, of acute ascend, paralysis, 94 

cerebro-spinal meningitis, 127 

chorea, 154 

epilepsy, 142 

gastralgia, 207 

headache, 222 

insomnia, 235 

spinal irritation, 82 

vertigo, 227 

Coffea in treat, of cerebral hyperemia, 18 

insomnia, 235 

Colchicum in treat, of aphasia, 38 

neuralgia, 170 

spinal hyperemia, 77 

vertigo, 228 

Colocynthis in treat, of enteralgia, 212 

gastralgia, 207 

headache, 217 

sciatica, 178 

Conium in treat, of aphasia, 38 

cerebral concussion, 52 

tumors, 50 

coecygodvnia, 176 

neuralgia", 170 

ovaralgia, 209 

spinal concussion, 114 

vertigo, 226 

Corralliurn rub. in treat, of spasm of glottis, 190 
Crotalus in treat, of cerebro-spinal meningitis, 

127 
Crocus in treat, of headache, 222 

mania, 247 

Cuprum in treat, of angina pectoris, 203 

cerebral hyperemia, 18 

meningitis, 65 

cerebro-spinal meningitis, 127 

chorea, 155 

epilepsy, 142 

enteralgia, 213 

infantile convulsions, 131 

mania, 247 

neuralgia, 172 

puerperal convulsions, 135 

spasm of glottis, 190 

spinal meningitis, 87 

vertigo, 225 

Cyclamen in treat, of hemicrania, 197 
Cvpripedium in treat, of infantile convulsions, 
* 132 



Digitalis in treat, of cerebral meningitis, 65 

chronic hydrocephalus, 74 

cerebro-spinal meningitis, 125 

puerperal convulsions, 136 

sunstroke, 54 

Dioscorea in treat, of enteralgia, 212 



Epiphegus in treat, of neurasthenia, 120 
Ergot in treat, of cerebral hyperemia, 21 
Erythroxvlon coca in treat, of neurasthenia, 
. 80, 119 

spinal anaemia, 80, 119 

Ether in treat, of sciatica, 180 
Eupatorium perf. in treat, of headache, 219 
Euphrasia in treat, of vertigo, 226 
headache, 217 



Ferrum in treat, of cerebral anaemia, 11 

gastralgia, 208 

Ferrum et strych. in treat, of ovaralgia, 109 
Fluoric acid in coccygodynia, 176 



Gamboge in treat, of headache, 221 
Gelsemium in treat, of acute ascending paral- 
ysis, 94 

myelitis, S9 

cerebral concussion, 51 

hyperemia, 17 

meningitis, 66 

cerebro-spinal meningitis, 124 

delirium tremens, 252 

diphtheritic paralysis, 186 

facial paralysis, 184 

headache, 218 

hemicrania, 196 

hysteralgia, 210 

infantile convulsions, 130 

cerebral paralysis, 57 

insomnia, 233 

locomotor ataxia, 109 

mania, 247 

neuralgia, 169 

ocular paralysis, 73 

ovaralgia, 209 

puerperal convulsions, 137 

spasm of glottis, 190 

spinal hyperemia, 77 

irritation, 82 

tetanus, 146 

vertigo, 228 

Glonoin in treat, of angina pectoris, 203 

aphasia, 38 

cerebral concussion, 51 

hyperemia, 15 

meningitis, 65 

"epilepsy, 142 

infantile convulsions, 131 

sunstroke, 53 

Gossypium in treat, of headache, 220 
Graphites in treat, of cerebral tumors, 49 
Gymnocladus in treat, of headache, 219 



Hamamelis in treat, of neuralgia, 168 

Hepar sulph. in treat, of spinal concussion, 114 

Helleborus in treat, of cerebral meningitis, 66 

chronic hydrocephalus, 74 

coma, 232 

infantile convulsions, 133 

locomotor ataxia, 109 

tubercular meningitis, 69 

Helonias in treat, of cerebral anaemia, 12 
Hoang Nan in treat, of hydrophobia, 150 
Hydrastis in treat, of headache, 220 
Hydrocyanic ac. in treat, of cerebro-spinal men- 
ingitis, 126 



INDEX. 



2(53 



Hydrocyanic ac in treat of epilepsy, 142 
— * — puerperal convulsions, 135 

tot anus, 146 

1 1 j . iscyamus in t real . of cerebral concussion, 51 
— ' — hyperemia, 16 

meningitis, 67 

cerebro-spinal meningitis, 126 

chorea, 154 

— — delirium tremens, 251 

infantile convulsions, 132 

insomnia, '235 

mania, 245 

puerperal convulsions, 136 

vertigo, 227 

Hypericum" in treat, of cerebral concussion, 51 
— " — spinal concussion, 114 

— — — irritation, 83 
meningitis, 86 

— — tetanus, 147 



Ignatia in treat, of cerebral anaemia, 11 

chorea, 154 

Liastralgia, 206 

infantile convulsions, 130 

— — insomnia, 235 

locomotor ataxia, 110 

melancholia, 238 

neuralgia, 172 

neurasthenia, 121 

ovaralgia, 209 

puerperal convulsions, 137 

sciatica, 179 

spinal irritation, 83 

vertigo, 225 

Indigo in treat, of epilepsy, 141 

Inula helen. in treat, of hydrophobia, 150 

Iodine in treat, of angina pectoris, 202 

encephalitis, 34 

melancholia, 239 

spasm of the glottis, 190 

Ipecacuanha in treat, of cerebral anaemia, 12 

headache, 215 

infantile convulsions, 133 

spasm of glottis, 190 

vertigo, 228 

Iris vers, in treat, of headache, 217 

hemicrania, 196 

neuralgia, 169 

Kali bichr. in treat, of headache, 222 

hemicrania, 197 

neuralgia, 170 

Kalibrom. in treat, of infantile convulsions, 130 

melancholia, 239 

spasm of glottis, 190 

Kali carb. in treat, of cerebral tumors, 49 

headache, 218 

neuralgia, 172 

Kali chlor. in treat, of facial paralysis, 184 
Kali cyan, in treat, of neuralgia, 170 
Kali iod. in treat, of angina pectoris, 202 

aphasia, 38 

cerebral syphilis, 47 

chronic hydrocephalus, 75 

facial paralysis, 184 

headache, 219 

ocular paralysis, 73 

sciatica, 179* 

spinal meningitis, 87 

tubercular meningitis, 70 

vertigo, 227 

Kali phos. in treat, of melancholia, 238 

spinal ana-mia, 80 

Kalmia in treat, of neuralgia, 168 

vertigo, 228 

Lachesis in treat, of angina pectoris, 204 

aphasia, 38 

cerebral concussion, 51 

haemorrhage, 24 



Lachesis in treat, of coma, 231 

headache, 215 

neuralgia, 169 

puerperal convulsions, 137 

spinal hyperemia, 77 

tetanus, 146 

vertigo, 225 

Lachnanthes in treat, of cerebral hyperemia, 18 
Lathyrus in treat, of locomotor ataxia, 109 

spinal hyperemia, 78 

Laurocerasus in treat, of angina pectoris, 203 

cerebral haemorrhage, 25 

concussion, 51 

Ledum in treat, of paralysis, 94 
Lilium tig. in treat, of headache, 221 
— ■ — ovaralgia, 209 
Lycopodium in treatment of aphasia, 37 

cerebro-spinal meningitis, 128 

coma, 232 

headache, 217 

melancholia, 238 

spinal anaemia, 80 

tubercular meningitis, 70 



Magnesia phos. in treat, of neuralgia, 168 
Mercurius in treat, of acute myelitis, 89 

cerebral syphilis, 47 

facial paralysis, 184 

headache, 220 

mania, 246 

myelitis, 89 

ocular paralysis, 73 

sciatica, 180 

spinal meningitis, 87 

Mercurius iod. in treat, of encephalitis, 34 
Mezereum in treat, of headache, 218 

neuralgia, 168, 172 

Moschus in treat, of insomnia, 235 
Mygale in treat, of chorea, 153 



Naja in treat, of ovaralgia, 209 
Natrum carb. in treat, of vertigo, 225 
Natruin iod. in treat, of angina pectoris, 202 
Natrum mur. in treat, of cerebral anaemia, 13 

headache, 221 

hemicrania, 198 

melancholia, 239 

— — neuralgia, 169 

spinal irritation, 83 

vertigo, 228 

Natrum nitrite in treat, of angina pectoris, 203 
Natrum salicyl. in treat, of vertigo, 225 
Natrum sulph. in treat, of cerebral anaemia, 13 

headache, 215 

Niccolum sulph. in treat, of hemicrania, 198 
Nicotinum in treat, of tetanus, 145 
Nux mosch. in treat, of coma, 232 

headache, 216 

Nux vom. in treat, of acute ascending paral- 
ysis, 95 

cerebral anaemia, 11 

haemorrhage, 24 

hyperemia, 17 

■ cerebro-spinal meningitis, 126 

chorea, 154 

enteralgia, 212' 

epilepsy, 140 

gastralgia, 205 

headache, 218 

infantile convulsions, 132 

insomnia, 234 

locomotor ataxia, 110 

mania, 246 

melancholia, 238 

neuralgia, 170, 172 

neurasthenia, 120 

ocular paralysis, 73 



264 



INDEX. 



Nux voui. in treat, of sciatica, 178 

spinal anaemia, 79 

meningitis, 86 

vertigo, 224 



CEnanthe cro. in treat, of epilepsy, 1-43 

puerperal convulsions, 137 

Opium in treat, of cerebral haemorrhage, 23 

hyperaeniia, 17 

meningitis, 66 

cerebro-spinal meningitis, 124 

coma, 231 

delirium tremens, 251 

enter algia, 213 

iufantile convulsions, 231 

insomnia, 234 

mania, 244 

ocular paralysis, 73 

puerperal convulsions, 137 

vertigo, 227 

Oxalic acid in treat, of acute myelitis, 90 

gastralgia, 207 

— ■ — locomotor ataxia, 110 

multiple cerebral sclerosis, 43 

myelitis, 90 



Passiflora in treat, of insomnia, 233 

tetanus, 146 

Phosphorus in treat, of acute ascending paraly- 
sis, 95 

acute myelitis, 90 

aphasia, 38 

cerebral haemorrhage, 23 

hyperaeniia, 18 

cerebro-spmal meningitis, 126 

headache, 220 

insomnia, 234 

locomotor ataxia, 108 

melancholia, 239 

multiple cerebral sclerosis, 43 

myelitis, 90 

neuralgia, 172 

neurasthenia, 119 

pseudo-hypertrophic paralysis, 100 

spinal anaemia, 79 

vertigo, 224 

Phosphoric ac. in treat, of coma, 232 

neurasthenia, 121 

vertigo, 228 

Physostigma in treat, of locomotor ataxia, 109 

infantile convulsions, 133 

spinal meningitis, 87 

neurasthenia, 120 

tetanus, 146 

vertigo, 228 

Phytolacca in treat, of headache, 127 

mastodynia, 174 

spasm of glottis, 190 

Picric acid in treat, of acute ascending paraly- 
sis, 95 

acute myelitis, 90 

cerebral softening, 35 

myelitis, 90 

neurasthenia, 120 

Pilocarpus in treat, of puerperal convulsions, 136 

Platina in treat, of enteralgia, 213 

headache, 218 

melancholia, 239 

Plumbum in treat, of acute myelitis, 89 

cerebro-spinal meningitis, 128 

chronic hydrocephalus, 75 

encephalitis, 34 

enteralgia, 213 

epilepsy, 143 

locomotor ataxia, 108 

melancholia, 239 



Plumbum in treat, of multiple cerebral sclero- 
sis, 43 

myelitis, 89 

neuralgia, 170 

sciatica, 179 

spasm of glottis, 190 

spinal meningitis, 87 

Podophyllum in treat, of enteralgia, 212 

headache, 218 

Pulsatilla in treat, of cerebral anaemia, 12 

haemorrhage, 24 

hyperaemia, 19 

chorea, 154 

coma, 231 

encephalitis, 34 

gastralgia, 207 

headache, 221 

hemicrania, 197 

insomnia, 235 

mastodynia, 175 

melancholia, 238 

neuralgia, 168 



Ehododendron in treat, of neuralgia, 168 

spinal hyperaemia, 77 

Ehus rad. in treat, of hysteralgia, 210 

coccygodynia, 176 

Rhus tox.'in treat, of acute ascending paral- 
ysis, 95 

cerebral haemorrhage, 24 * 

hyperaemia, 18 

cerebro-spinal meningitis, 127 

coma, 231 

mastodynia, 175 

multiple cerebral sclerosis, 44 

sciatica, 178 

spinal concussion, 114 

hyperaemia, 77 

irritation, 83 

meningitis, 87 

Euniex in treat, of headache, 221 
Euta in treat, of coccygodynia, 176 



Sabina in treat, of neuralgia, 169 

Sambucus in treat, of spasm of the glottis, 190 

Sanguinaria in treat, of cerebral haemorrhage, 24 

headache, 222 

hemicrania, 196 

Scutellaria in treat, of headache, 221 

sunstroke, 53 

Secale in treat, of acute ascending paralysis, 95 

acute myelitis, 89 

cerebral anaemia, 13 

hyperaemia, 21 

— — coma, 232 
myelitis, 89 

spinal hyperaemia, 77 

irritation, 83 

meningitis, 87 

Senega in treat, of vertigo, 225 

Sepia in treat, of cerebral haemorrhage, 25 

tumors, 49 

headache, 215 

— — hemicrania, 195 

hysteralgia, 210 

mania, 247 

neuralgia, 173 

vertigo, 227 

Silicea in treat, of cerebral syphilis, 47 

epilepsy, 143 

encephalitis, 34 

headache, 216 

insomnia, 235 

locomotor ataxia, 110 

spinal hyperaemia, 77 

tubercular meningitis, 71 

vertigo, 225 



INDEX. 



265 



Spigelia in trout, of angina pectoris, 203 

— — hemierania, 197 

neuralgia, 167, 17:: 

ocular paralysis, 7:; 

Spirsea aim. in treat, of hydrophobia, 150 
Spongia in treat, of angina pectoris, 202 

tubercular meningitis, 70 

Staphisagria in treat, of neurasthenia, 120 
Stannum in treat, of gastralgia, 208 

hemierauia. 196 

infantile cerebral paralysis, 57 

convulsions, 132 

Stillingia in treat, of headache, 221 
Stramonium in treat, of aphasia, 38 

cerebral hyperemia, 16 

meningitis, 65 

chorea, 155 

coma, 231 

delirium tremens, 251 

headache, 218 

infantile convulsions, 131 

insomnia, 235 

mania, 244 

ocular paralysis, 73 

puerperal convulsions, 136 

spinal meningitis, 87 

tetanus, 146 

vertigo, 227 

Strychnia in treat, of cerebral softening, 36 
Strychnia phos. in treat, of neurasthenia,80,119 

— — spinal anaemia, 80 
irritation, 82 

Sulphur in treat, of cerebral anaemia, 13 

hyperaernia, 19 

chorea, 155 

chronic hvdrocephalus, 74 

headache," 216 

insomnia, 236 

multiple cerebral sclerosis, 44 

vertigo, 228 

.Sulphuric ac. in treat, of spinal concussion, 114 



Tanacetum in treat, of hydrophobia, 150 
Tartar emet. in treat, of "coma, 231 

neuralgia, 169 

Tarantula in treat, of chorea, 154 

coccygodynia, 176 

mania, 248 

multiple cerebral sclerosis, 44 

spinal irriration, 83 

vertigo, 227 

Tellurium in treat, of spinal irritation, 85 
Thaspium aur. in treat, of epilepsy, 143 



Thuja in treat, of neuralgia, 172 
coccygodynia, 176 

Valerian in treatment of sciatica, 180 
Veratrum alb. in treat, of acute myelitis, 89 

angina pectoris, 203 

cerebral amemia, 12 

cerebro-spinal meningitis, 126 

coma, 231 

gastralgia, 207 

hemierania, 197 

infantile convulsions, 131 

melancholia, 240 

myelitis, 90 

neuralgia, 169 

tubercular meningitis, 70 

vertigo, 225 

Veratrum vir. in treat, of cerebral concussion, 55 

hyperemia, 17 

cerebro-spinal meningitis, 124 

chorea, 155 

infantile convulsions, 133 

insomnia, 234 

puerperal convulsions, 136 

sunstroke, 53 

tetanus, 147 

Vipera in treat, of cerebral concussion, 53 

Xanthium spin, in treat, of hydrophobia, 150 

Zinc brom. in treat, of cerebral anaemia, 12 

neurasthenia, 120 

Zinc oxyd. in treat, of multiple cerebral scle- 
rosis, 43 
Zinc phos. in treat, of cerebral anaemia, 12 

softening, 36 

neuralgia, 170, 

neurasthenia, 121 

Zinc pier, in treat, of cerebral anaemia, 12 

neurasthenia, 120 

Zinc val. in treat, of insomnia, 235 

ovaralgia, 209 

Zincum in treat, of cerebral anaemia, 12 

cerebro-spinal meningitis, 128 

chronic hydrocephalus, 75 

chorea, 155 

coccygodynia, 176 

encephalitis, 34 

infantile convulsions, 132 

locomotor ataxia, 109 

neuralgia, 173 

neurasthenia, 120 



Section III. — French Synonyms. 



Abces cerebrale, 32 

— du cerveau, 32 

— de Pencephale, 32 
Anemie cerebrale, 9 

— cerebro-spinale, 117 

— du cerveau, 9 
Anesthesie cutanee, 192 
Angine de poitrine, 200 
Aphasie. 37 

Aplasie lamineuse progressive, 191 
Apoplexie cerebrale, 21 

— de la moe'lle epiniere, 84 

— meningee, 59 
Arachnite spinale, 85 
Ataxie locomotrice, 107 
Athetose, 44 
Atrophie cerebrale, 40 

— du cerveau, 40 

— muscularie graisseuse progressive, 101 

— partielle de J a face, 191 



Catalepsie, 161 
Cephalalgia 214 
Commotion cerebrale, 50 

— du cerveau, 50 

— de la moe'lle epiniere, 112 

— spinale, 112 
Congestion cerebrale, 14 

— cerebro-spinale, 116 

— du cerveau, 14 
Coup de soleil, 52 
Convulsions de l'enfance, 129 

— des femmes encientes et en couche, 134 

— toxemiques, 138 
Crampe des ecrivains, 188 



Danse de St. Guy, 152 
— de St. Witt, 152 

Degenerations secondaires de la moe'lle epi- 
niere, 162 



266 



INDEX. 



Delire crapuleuse, 250 

— ebrieuse, 250 
Deruence, 252 
Diplegie faciale, 184 
Douleur de tete, 214 

— de coccyx, 175 



Embolie cerebrale, 30 
Encephalite chronique, 32 
Epilepsie, 139 



Fievre cerebrale, 67 
Folie niusculaire, 152 
— raisoimante, 241 
Fortraiture, 210 
Fureur, 243 



Gastralgie, 204 

Goitre exophthalniique, 198 



Haut mal, 139 

Hematomyele, 84 

Hemorrhagic cerebrale interstitielle, 21 

— des meninges, 59 

— du cerveau, 21 

— meningee cerebrale, 59 

— intraracbienne, 84 
Hydrocephale, 73 
Hydropbobie, 148 
Hydropsie du cerveau, 73 
Hyperemie cerebrale, 14 

— cerebro-spinale, 116 

— de la moelle epiniere, 76 
Hypertrophic cerebrale, 39 

— du cerveau, 39 
Hyi^ochondrie, 240 
Hysterie, 156 

— epileptiforme, 159 
Hystero-epilepsie, 159 



Inflammation de l'aracbnoide, 60 

— del'encephale, 32 

— de la moelle epiniere, 88 
Insomnie, 232 



La choree, 152 

La rage, 148 

Leptomeningite spinale, 85 

Les degenerations secondaires de la moelle 

— epiniere, 106 

Lypemanie, 237 



Maladie de Graves, 198 

— imaginaire, 156 
Mal a tete, 214 

— de mere, 156 

— Divin, 139 
Manie aigue', 243 

— crapuleuse, 249 

— ebrieuse, 249 

— sans delire, 241 
Melancholie, 237 

Meningite cerebrale cbronique, 71 

— cerebro-raehidienne, 123 

— cerebro-spinale, epidemique, 123 

— consecutifs a la carie du rocher, 61 

— epidemique, 123 

— granuleuse, 67 

— simple, 62 

— spinale, 85 



Meningite tuberculeuse, 67 
Migraine, 195 
Monomanie affective, 241 
Myelite, 88 
Myxedeme, 199 



Nevralgie, 167 

— des mamelles, 174 

— des ovaires, 208 

— intestinale, 211 

— sciatique, 177 
Xevrite, 166 



Pacbymeningite cerebrale, 58 
cbronique, 71 

— secondaire, 58 

— spinale, 85 
Paraplegie, 92 

— functionelle, 78 

— bypertropbique de l'enfance, 98 

— reflexe, 78, 93 
Paralysie agitante, 164 

— ascendante aigue, 94 

— atropbique graisseuse de l'enfance, 97 

— cerebrale, 56 
de l'enfance, 56 

— de la Ian que, 186 

— diphtheritique, 185 

— du larynx, 99, 181 

— du pharynx, 99, 181 

— essentieile de l'enfance, 97 

— faciale, 184 

— generate incomplete, 163 

— glosso-labio-laryngee, 99 

— laryngee, 181 

— musculaire progressive atropbique, 101 

— myosclerosique, 98 

— pharyngee, 181 

— pseudo-hypertropbique, 98 

— spinale, 92 . 

atrophique, 95 

de l'adulte, 95 

— tremblante, 164 
Periencepbalite cbronique diffuse, 163 



Racbialgie, 81 
Eamollissement cerebrale, 34 

— de la moelle epiniere, 88, 90 

— spinale, 88, 90 



Sclerose en plaques disseminees, 42, 103, 162 

— laterale amyotropliique, 102 
Spasm e de la glotte, 189 

— faciale, 187 
Stupeur, 229 
Sypbilis du cerveau, 45 



Tabes dorsal spasmodique, 105 
Tetanos, 144 
Thrombose cerebrale, 27 
Tic-convulsif, 187 

— douloureux, 171 
Torticollis, 187 
Trisme de l'enfance, 134 
Tropbonevrose faciale, 191 
Tumeurs de la moelle epiniere, 112 

— du cerveau, 48 

— racbidiennes, 112 



Vertige, 223 



INDEX. 



267 



Section IV. — German Synonyms. 



Akute (Ymvoxihits Meningitis, 61 

— SpinaMhmung bei Erwachsenen, 95 

— and Chronische Enkephalitis, 32 
AUgemeine Akute Hirnhautentzundung, 65 

— Progressive Gehirnlfihmung, 163 
Amyotrophique Lateral-sklerose des Riieken- 

marks, 102 
Ansosthesia, 192 
Anamie des Gehirns, 9 
Anasthesie, 192 
Aphasie, 37 
Apoplexie, 21 
Athetose, 44, 56 
Atrophie des Gehirns, 40 



Basedow'sehe Krankheit, 198 
Blodsinn, 252 
Brustbraune, 200 



Cerebrale Abscess, 32 

— Eiterbeule, 32 

— Gescbwiir, 32 

— Kinderlahniung, 56 

— Pachymeningitis, 5S 

— Typhus, 123 
Cerebro-spinale Anamie, 117 
Hyperamie, 116 

Chronische Convexitats Meningitis, 71 

— Hirnhautentzundung, 71 
Convulsivische Starrsucht, 161 
Darmweh, 211 

Der Wasserkopf, 73 
Diphtheritiscbe Lahmung, 185 
Diplegia Facialis, 184 



Eiterbeule des Gehirns, 32 
Eklampsieblutvergiftung, 138 

— der Xeugeborenen, 134 

— in der Schwangerschaft und im Wochen- 

bette, 1:34 
EmboUe der Hirnarterien, 30 
Enkephalentziindung, 32 
Entzundung der Arachnoidea, 60 

— der Nerven, 166 
Epideraische Meningitis, 123 
Erschiitterung des Gehirns, 50 

— des Riickenmarks, 113 
Erweichung des Gehirns, 34 

— des Riickenmarks, S5, 88, 90 



Fallsucht, 139 



Gehirnanamie, 9 
Gehirn atrophie, 40 
Gehirnblutungen, 21 
Gehirnerweichung, 34 « 

Gehirnhypertrophie, 39 
Gebirniahmung, 54 
Gehirnhyperamie, 14 
Gehirnapoplexie, 21 
Geisteskrankheit, 243 
Gemiithswabnsinn, 241 
Genickkrampf, 123 
Genickstarre, 123 
Geschwiilste des Gehirns, 48 
— des Riickenmarks, 111 
Gesichtkrampf, 187 
Gesichtlahmung, 184 
Glotzaugenkropf, 198 

Graue Degeneration der Hinterstrange 
Riickenmarks, 107 



Halsstarre, L87 

Hamatome der Dura Mater, 59 
Hemicranie, "196 
Birnarterienversperrung, 27, 30 
Hirnblutung, 21 
HirngescliwUr, 32' 
BQrngeschwiilste, 48 
Hirnhautentziindung, Akute, 65, 95 

Chronische, 71 
Hirnlahmung, 54 
Hirnlustseuche, 45 
Hirnschlag, 21 
Hirnwassersucht, 73 
Hundswuth, 148 
Hiii'tweh, 177 

Hyperamie des Gehirns, 14 
Hypertrophic des Gehirns, 39 
Hvpoehondrie, 240 
Hysterie, 156 
Hystero-Epilepsie, 159 



Kehlkopfkrampf, 189 
Kehlkopflahmung, 99, 181 
Kinderzuckung, 129 
Kinderkrampf, 129 
Kinderstarrkrampf, 134 
Kinderlahmung des Gehirns, 56 
Kopfschmerz, 214 
Krankhafte Geschwiilste des Gehirns, 84 

des Riickenmarks, 112 

Kreuzendschmerz, 175 



Magenschmerz, 204 
Melancholic, 237 

Migrane, 195 

Milzkrankheit, 240 

Milzsucht, 240 

Multiple Cerebro-spinale Sklerose, 162 

— Sklerose des Gehirns, 42 

des Riickenmarks, 103 

Muskelatrophie, 98, 101 

— mit Interstitieller Lipomatose, 98 
Muskellahmung, 98, 101 
Mutterbeschwerde, 156 
Myxademe, 199 



Nerventziindung, 166 
Neuralgie, 167 

— der Brustdriisen, 174 

— derEierstocke, 208 

— der Eingeweide, 211 

— des Fiinftennerven, 171 

— der Gebarmutter, 210 

— der Ovarien, 208 

— der Trigeminus, 171 
Neuritis, 164 
Paralytischer Blodsinn, 163 

Primare Lateralsklerose des Riickenmarks, 105 
Paralysis Ascendens Acuta, 94 
Poliomyelitis Anterior, 95 
Primare Sklerose der Seitenstrange des Riicken- 
marks, 105 
Progressive Bulbarparalysie, 99 
Prosopodysmorphia, 191 



Reflex Paralysis Spinalis, 78 
Riickenmarksapoplexie, 84 
Riickenmarkshautentziindung, 85 
Riickenmarksentziindung, 88 
Riickenmarkshyperamie, 76 
Ruckgratschmerz, 81 



268 



INDEX. 



Schlaflosigkeit, 232 
Schlagfluss, 21 
Schlundkopflahmung, 181 
Schreibekrampf, 188 
Schiittellahmung, 164 
Schwermuth, 237 
Schwindel, 223 

SecundareErkrankungEinzelnerRiickeninarks- 
strange, 106 

— Cerebro-spinale Sklerose, 162 

— Pachymeningite, 58 

— Leptomeningite, 61 
Sonnenstich, 52 

Spatische Spinalparalysie, 105 

Spinale Hyperamie, Spinalhyperamie, 76 

— Kinderlahmung, Spinalkinderlahmung, 97 

— Meningitis, Spinalmeningitis, 85 
Spinallahmung, 92 

— bei Erwachsenen, 95 
Spinalparalysie, 92 
Sprachlahmung, 37 
Starrkrampf, 144 
Steifer Hals, 187 
Stimmlosigkeit, 181 
Stumpfsinn, 229 

Syphilitische Gehirn Erkrankung, 45 



Thrombose der Hirnarterien, 27 

— Cerebralis, 27 

Tobsucht, 243 

Tollheit. 243 

Tollwuth, 148 

Toxamische Eklampsie, 138 

Trunksucht, 249 

Tuberculose Hirnhautentziindung, 67 



Unsinnigkeit, 243 



Veitstanz, 152 



Wasserkopf, 73 
Wasserscheu, 148 
Wutb, 243 



Zitterwahnsinn, 250 
Zungenlabmung, 186 




m 




